Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | WY |
NPI | 1053806703 |
---|---|
Provider Name | Andrew Nielsen |
First Address | Gillette, WY 82718-2017 |
Second Address | Gillette, WY 82718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 18/07/2018 |