Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-2794 | ID |
N | 2251S0007X | Physical Therapist - Sports | PT-2794 | ID |
NPI | 1215233952 |
---|---|
Provider Name | David Tyler Billings |
First Address | Twin Falls, ID 83301-3455 |
Second Address | Twin Falls, ID 83301-3455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 27/01/2011 |