Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 847 | NE |
NPI | 1013397538 |
---|---|
Provider Name | Martin Stoddard |
First Address | Omaha, NE 68137-1124 |
Second Address | Omaha, NE 68137-1124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 01/06/2015 |