Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01418100 | NJ |
NPI | 1003199837 |
---|---|
Provider Name | Dr. David Michael Kittle |
First Address | Maple Shade, NJ 08052-2319 |
Second Address | Ewing, NJ 08628-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2011 |
Last Update Date | 28/09/2011 |