Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10767 | AZ |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1043602931 |
---|---|
Provider Name | Jonathan Seidberg |
First Address | Phoenix, AZ 85044-6691 |
Second Address | Phoenix, AZ 85016-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2015 |
Last Update Date | 02/03/2015 |