Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA012429 | OH |
NPI | 1003429804 |
---|---|
Provider Name | Joshua Thompson |
First Address | Independence, OH 44131-2319 |
Second Address | Independence, OH 44131-2319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2020 |
Last Update Date | 31/08/2020 |