Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA.08648 | OH |
NPI | 1003225822 |
---|---|
Provider Name | Joseph Gillis |
First Address | Canton, OH 44718 |
Second Address | Cuyahoga Falls, OH 44223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2014 |
Last Update Date | 06/08/2014 |