Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003291808 |
---|---|
Provider Name | Jesse Holliday |
First Address | College Park, MD 20740-4530 |
Second Address | Lanham, MD 20706-3511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2015 |
Last Update Date | 22/07/2015 |