Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT4112 | CA |
NPI | 1003908542 |
---|---|
Provider Name | Donald Slate |
First Address | Milwaukie, OR 97222 |
Second Address | Milwaukie, OR 97222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |