Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 112026 | AK |
NPI | 1013460625 |
---|---|
Provider Name | James Matthew Sliwa |
First Address | Wasilla, AK 99654-5475 |
Second Address | Wasilla, AK 99654-7378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2016 |
Last Update Date | 31/07/2016 |