Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 36136 | CA |
NPI | 1013589670 |
---|---|
Provider Name | Dr. Jayson Bryant Merrill |
First Address | Concord, CA 94518-1443 |
Second Address | Concord, CA 94518-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2021 |
Last Update Date | 07/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013589670 | (05) | CA |