Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 001614 | KY |
Y | 2251S0007X | Physical Therapist - Sports | 001614 | KY |
NPI | 1023437217 |
---|---|
Provider Name | Dr. John Aaron Nyland |
First Address | Louisville, KY 40203-2213 |
Second Address | Louisville, KY 40203-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 15/04/2014 |