Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 02660 | RI |
NPI | 1417050402 |
---|---|
Provider Name | Dr. Jeff G Konin |
First Address | Kingston, RI 02881-1126 |
Second Address | Kingston, RI 02881-1126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2251S0007 | (02) | RI |