Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1639546542 |
---|---|
Provider Name | Anthony Reppond |
First Address | Madison, MS 39110-6322 |
Second Address | Madison, MS 39110-6322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 09/11/2015 |