Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 11-06321 | KS |
NPI | 1477197978 |
---|---|
Provider Name | Jacob Allen Dean Mcfarland |
First Address | Overland Park, KS 66223-3378 |
Second Address | Overland Park, KS 66221-9398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |