Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 006893 | OH |
NPI | 1073626610 |
---|---|
Provider Name | Mark Douglas Mcentire |
First Address | Mason, OH 45040 |
Second Address | Mason, OH 45040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |