Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist | ||
Y | 226300000X | Kinesiotherapist | 226300000X | TN |
NPI | 1023396470 |
---|---|
Provider Name | John Kleamenakis |
First Address | Metairie, LA 70003-7634 |
Second Address | Murfreesboro, TN 37129-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2011 |
Last Update Date | 02/08/2011 |