Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT028539 | PA |
NPI | 1083230460 |
---|---|
Provider Name | Justin Thomas David |
First Address | Pittsburgh, PA 15234-1431 |
Second Address | Pittsburgh, PA 15234-1431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2020 |
Last Update Date | 22/06/2020 |