Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE000820L | PA |
NPI | 1013053404 |
---|---|
Provider Name | Christopher Michael Troutman |
First Address | Media, PA 19063-5104 |
Second Address | Media, PA 19063-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |