Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | IL | |
N | 226300000X | Kinesiotherapist | 1290 | IL |
NPI | 1831391234 |
---|---|
Provider Name | Douglas George Kleber |
First Address | Urbana, IL 61801-1127 |
Second Address | Urbana, IL 61801-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |