Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003306937 |
---|---|
Provider Name | Benjamin Tappen Kern |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Seattle, WA 98105-4631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2018 |
Last Update Date | 16/05/2018 |