Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1700810181 |
---|---|
Provider Name | Jimmy Lindsey Nichols |
First Address | Dobbs Ferry, NY 10522-2404 |
Second Address | Bronx, NY 10468-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |