Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A1449 | MN |
NPI | 1013354216 |
---|---|
Provider Name | Aleksandr Voznyuk |
First Address | Plymouth, MN 55446-2454 |
Second Address | Plymouth, MN 55446-2454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2013 |
Last Update Date | 28/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A1449 | MN BOARD OF PT (01) | MN |