Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 2020 | MS |
NPI | 1487113155 |
---|---|
Provider Name | Charles Herrington |
First Address | Prattville, AL 36067-6632 |
Second Address | Selma, AL 36701-6949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2019 |
Last Update Date | 13/03/2019 |