Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | VA |
NPI | 1437596657 |
---|---|
Provider Name | Delshaun Tyron Mcrae |
First Address | Mechanicsville, VA 23116-2848 |
Second Address | Richmond, VA 23249-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2013 |
Last Update Date | 29/05/2013 |