Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5131 | AZ |
NPI | 1003080086 |
---|---|
Provider Name | Jack C. Furr III |
First Address | Prescott, AZ 86301 |
Second Address | Prescott, AZ 86301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2008 |
Last Update Date | 30/08/2012 |