Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 010567 | NY |
NPI | 1073505087 |
---|---|
Provider Name | Kenneth David Rescott |
First Address | Auburn, NY 13021-2662 |
Second Address | Auburn, NY 13021-2662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02226626 | (05) | NY |
P35324 | (02) |