Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 491 | TX |
NPI | 1952454233 |
---|---|
Provider Name | David J. Greenway |
First Address | Fort Worth, TX 76104-2934 |
Second Address | Fort Worth, TX 76104-2934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 05/02/2008 |