Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1469 | IL |
NPI | 1033167754 |
---|---|
Provider Name | Gary Bolden |
First Address | Arlington, VA 22204-1932 |
Second Address | Washington, DC 20024-3621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 19/10/2007 |