Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5501019336 | MI |
N | 225100000X | Physical Therapist | 5501019336 | MI |
NPI | 1013558410 |
---|---|
Provider Name | Jonathan Taljonick |
First Address | Clio, MI 48420-2307 |
Second Address | Clio, MI 48420-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2019 |
Last Update Date | 07/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501019336 | STATE OF MICHIGAN (01) | MI |