Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 034028 | NY |
NPI | 1124408646 |
---|---|
Provider Name | Christopher Horan |
First Address | Oceanside, NY 11572 |
Second Address | Oceanside, NY 11572-5907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 01/06/2015 |