Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 2000013842 | CO |
NPI | 1336510593 |
---|---|
Provider Name | Eric Co Harbour |
First Address | Lakewood, CO 80214-4235 |
Second Address | Georgetown, CO 80444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2015 |
Last Update Date | 14/10/2015 |