Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA003964 | GA |
NPI | 1003434606 |
---|---|
Provider Name | Christian Aguilar |
First Address | Kathleen, GA 31047-2157 |
Second Address | Warner Robins, GA 31088-6399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2020 |
Last Update Date | 09/07/2020 |