Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1301851 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1093213845 |
---|---|
Provider Name | Dr. John Dalton Birlin |
First Address | Plano, TX 75093-8201 |
Second Address | Plano, TX 75093-8201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 14/10/2021 |