Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 05001300A | IN |
NPI | 1083030209 |
---|---|
Provider Name | Lowell Straw |
First Address | Lafayette, IN 47904-2134 |
Second Address | Lafayette, IN 47904-2163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2014 |
Last Update Date | 12/03/2014 |