Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 8565 | AZ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 8565 | AZ |
NPI | 1255562625 |
---|---|
Provider Name | Carl M Biscontini |
First Address | Gilbert, AZ 85297-3079 |
Second Address | Gilbert, AZ 85297-3079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 23/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036551 | (02) | AZ |