Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1055 | SD |
NPI | 1003068941 |
---|---|
Provider Name | Jason Gauer |
First Address | Aberdeen, SD 57402-4400 |
Second Address | Aberdeen, SD 57401-4527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 15/05/2015 |