Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | T6108 | MD |
Y | 225100000X | Physical Therapist | 11996 | OH |
NPI | 1033304381 |
---|---|
Provider Name | Joshua Tennant |
First Address | Clinton, MD 20735-3358 |
Second Address | La Plata, MD 20646-5984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 03/02/2012 |