Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT019502 | OH |
NPI | 1063189793 |
---|---|
Provider Name | Daniel Price |
First Address | Mentor, OH 44060-4907 |
Second Address | Mentor, OH 44060-4907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |