Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 13178 | AZ |
Y | 225100000X | Physical Therapist | 13178 | AZ |
NPI | 1023533726 |
---|---|
Provider Name | Daniel Holtgrewe |
First Address | Chandler, AZ 85224-5223 |
Second Address | Chandler, AZ 85224-5223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2017 |
Last Update Date | 03/08/2017 |