Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1194920843 |
---|---|
Provider Name | James Todd Ketron |
First Address | Kingsport, TN 37660-3220 |
Second Address | Kingsport, TN 37660-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |