Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | MI |
NPI | 1013419696 |
---|---|
Provider Name | Jacob Kaine Yates |
First Address | Fenton, MI 48430-2499 |
Second Address | Novi, MI 48374-1233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |