Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT.015401 | OH |
NPI | 1003296351 |
---|---|
Provider Name | Matthew Whalen |
First Address | Columbus, OH 43204-4947 |
Second Address | Columbus, OH 43209-2827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 02/06/2015 |