Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | N/A | MN |
NPI | 1013927375 |
---|---|
Provider Name | Justin E Brank |
First Address | Golden Valley, MN 55422-4249 |
Second Address | Golden Valley, MN 55422-4249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |