Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | PA | |
Y | 225200000X | Physical Therapy Assistant | TEI005498 | PA |
NPI | 1003459116 |
---|---|
Provider Name | Joshua Pike |
First Address | Altoona, PA 16601-1631 |
Second Address | State College, PA 16803-4610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2019 |
Last Update Date | 21/10/2019 |