Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 14114 | NC |
NPI | 1003155433 |
---|---|
Provider Name | Christopher Backus |
First Address | Greensboro, NC 27405-5666 |
Second Address | Winston Salem, NC 27103-4138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 27/02/2014 |