Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 011815 | OH |
NPI | 1750905188 |
---|---|
Provider Name | Alex Eubank |
First Address | Pickerington, OH 43147-7942 |
Second Address | Columbus, OH 43210-1229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2020 |
Last Update Date | 01/06/2020 |