Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT28591 | FL |
NPI | 1043640477 |
---|---|
Provider Name | Adam Mcmullen |
First Address | St Augustine, FL 32086-4202 |
Second Address | St Augustine, FL 32086-4202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2013 |
Last Update Date | 21/11/2013 |