Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 005751 | KY |
NPI | 1205134830 |
---|---|
Provider Name | Brandon Lee Zeller |
First Address | Pikeville, KY 41502-2530 |
Second Address | Harold, KY 41635-7064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2011 |
Last Update Date | 07/03/2011 |