Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 229 | WY |
NPI | 1013148642 |
---|---|
Provider Name | David Michael Luna |
First Address | Cheyenne, WY 82009-4842 |
Second Address | Cheyenne, WY 82009-4842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 30/07/2009 |