Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 3022 | MN |
NPI | 1427499631 |
---|---|
Provider Name | Jonathan D Conway |
First Address | Minneapolis, MN 55408-3513 |
Second Address | Eden Prairie, MN 55344-7334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2013 |
Last Update Date | 16/07/2013 |