Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 102043 | IA |
NPI | 1013501501 |
---|---|
Provider Name | Drew Eugene Maddison |
First Address | Ankeny, IA 50023-8995 |
Second Address | Ankeny, IA 50023-8995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 24/02/2021 |