Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 03934 | IA |
Y | 225100000X | Physical Therapist | 2462 | NE |
NPI | 1003142126 |
---|---|
Provider Name | Dr. James Baxa |
First Address | Omaha, NE 68122-2602 |
Second Address | Omaha, NE 68122-2602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2009 |
Last Update Date | 23/10/2009 |