Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1932647963 |
---|---|
Provider Name | Jason West |
First Address | Henrico, VA 23231-6201 |
Second Address | Richmond, VA 23249-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2017 |
Last Update Date | 10/02/2017 |