Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 07033 | OH |
NPI | 1003187972 |
---|---|
Provider Name | Kyle Gayheart |
First Address | Cardington, OH 43315-9755 |
Second Address | Columbus, OH 43209-2827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |