Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 12426-24 | WI |
NPI | 1447706445 |
---|---|
Provider Name | Joby Philip |
First Address | Milwaukee, WI 53233-1305 |
Second Address | Milwaukee, WI 53233-1305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 30/08/2016 |