Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023300993 |
---|---|
Provider Name | Kyle Jones |
First Address | Yerington, NV 89447-8722 |
Second Address | Yerington, NV 89447-8722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 10/05/2011 |