Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TEI002759 | PA |
NPI | 1003487133 |
---|---|
Provider Name | John Kline |
First Address | Johnstown, PA 15906-2745 |
Second Address | Johnstown, PA 15906-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2021 |
Last Update Date | 21/07/2021 |