Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 225100000X | Physical Therapist | PT12014 | FL |
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1407995533 |
---|---|
Provider Name | Dr. Willem Richard Stegeman |
First Address | Tampa, FL 33624-1853 |
Second Address | Tampa, FL 33624-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 20/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
887212100 | (05) | FL |