Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1922565787 |
---|---|
Provider Name | Ledirrius Houston |
First Address | Meridian, MS 39305-9405 |
Second Address | Tuscaloosa, AL 35404-5015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2019 |
Last Update Date | 27/02/2019 |