Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 0013539 | CO |
NPI | 1124494737 |
---|---|
Provider Name | Ethan Paster |
First Address | Tucson, AZ 85716-1114 |
Second Address | Tucson, AZ 85712-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 18/08/2015 |