Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1518142215 |
---|---|
Provider Name | Mark Root |
First Address | Columbia, SC 29209-1900 |
Second Address | Columbia, SC 29209-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2008 |
Last Update Date | 01/01/2008 |