Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3836 | NM |
NPI | 1003139726 |
---|---|
Provider Name | Chris Kotter |
First Address | Alamogordo, NM 88311-2860 |
Second Address | Alamogordo, NM 88310-5012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2010 |
Last Update Date | 11/07/2013 |