Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160040882W | WA |
NPI | 1003050469 |
---|---|
Provider Name | James Robert Perrone |
First Address | Park City, UT 84098-7605 |
Second Address | Park City, UT 84098-7605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/04/2009 |