Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05013339A | IN |
N | 2251X0800X | Physical Therapist - Orthopedic | 05013339A | IN |
NPI | 1053971564 |
---|---|
Provider Name | Daniel Huckstep |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 13/03/2021 |