Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT017995 | OH |
NPI | 1073174173 |
---|---|
Provider Name | Matthew Kanetzke |
First Address | Cincinnati, OH 45229-2833 |
Second Address | Cincinnati, OH 45229-2833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |