Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 4850 | NC |
NPI | 1003214818 |
---|---|
Provider Name | Joshua Jefferys |
First Address | Sanford, NC 27330-6953 |
Second Address | Sanford, NC 27330-6953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2014 |
Last Update Date | 10/12/2014 |