Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PTH5850 | AL |
NPI | 1013225085 |
---|---|
Provider Name | Dr. Jeremy Chad Fletcher |
First Address | Mobile, AL 36640-0277 |
Second Address | Mobile, AL 36688-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2010 |
Last Update Date | 15/10/2015 |