Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10212 | MN |
NPI | 1003276908 |
---|---|
Provider Name | Henry Byl |
First Address | Oakdale, MN 55128-6629 |
Second Address | North Mankato, MN 56003-1913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 04/03/2016 |