Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | VA |
NPI | 1942411400 |
---|---|
Provider Name | Blaine Allen Coon |
First Address | Salem, VA 24153-6404 |
Second Address | Salem, VA 24153-6404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 18/11/2015 |