Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2305208742 | VA |
NPI | 1063824548 |
---|---|
Provider Name | James Wilfred Picard III |
First Address | Richmond, VA 23229-5948 |
Second Address | Glen Allen, VA 23059-2629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 28/10/2014 |