Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8616 | MN |
NPI | 1023336955 |
---|---|
Provider Name | Dr. Jared Philip Bueche |
First Address | Jbsa Lackland, TX 78236-5638 |
Second Address | Jbsa Lackland, TX 78236-5638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 23/09/2021 |