Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 044568 | NY |
NPI | 1053959304 |
---|---|
Provider Name | Jackson Sanna |
First Address | Rochester, NY 14618-5647 |
Second Address | Rochester, NY 14618-5647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2019 |
Last Update Date | 17/12/2019 |