Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6991 | GA |
NPI | 1043287394 |
---|---|
Provider Name | Andrew Dwight Contreras |
First Address | Fort Bragg, NC 28310 |
Second Address | Fort Bragg, NC 28310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 08/07/2007 |