Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3715 | DE |
NPI | 1245863208 |
---|---|
Provider Name | Bernard Paul Tabungar |
First Address | Dracut, MA 01826-4450 |
Second Address | Dracut, MA 01826-4450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2020 |
Last Update Date | 18/02/2020 |