Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | P17740 | NC |
NPI | 1003319518 |
---|---|
Provider Name | Cristopher Dinofa |
First Address | Wilmington, NC 28411-7876 |
Second Address | Hampstead, NC 28443-7313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2018 |
Last Update Date | 10/03/2018 |