Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1272156 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1272156 | TX |
NPI | 1316484736 |
---|---|
Provider Name | Dr. Taro Wichman |
First Address | Houston, TX 77215-0211 |
Second Address | Houston, TX 77074-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2017 |
Last Update Date | 23/01/2017 |