Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist |
NPI | 1962082701 |
---|---|
Provider Name | Cory Hisle |
First Address | Greenfield, IN 46140-7304 |
Second Address | Greenfield, IN 46140-7304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |