Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0418 | NV |
NPI | 1013454180 |
---|---|
Provider Name | Joe Douglas Johnson |
First Address | Reno, NV 89508-9511 |
Second Address | Reno, NV 89509-4515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2017 |
Last Update Date | 26/01/2017 |