Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 28236 | FL |
NPI | 1003263336 |
---|---|
Provider Name | James Hanson |
First Address | Arcadia, FL 34269-4088 |
Second Address | Arcadia, FL 34269-4088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2016 |
Last Update Date | 17/05/2016 |