Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A3361 | MD |
NPI | 1003469271 |
---|---|
Provider Name | Emmanuel Mensah |
First Address | Frederick, MD 21703-2750 |
Second Address | Rockville, MD 20850-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2019 |
Last Update Date | 17/07/2019 |