Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 5501020051 | MI |
NPI | 1194252569 |
---|---|
Provider Name | Charles Emmett Zepp |
First Address | Fenton, MI 48430-3329 |
Second Address | Columbus, OH 43219-3675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016839 | OHIO LICENSE (01) | OH |