Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-021629 | PA |
NPI | 1003190620 |
---|---|
Provider Name | Michael N Mount |
First Address | Kennett Square, PA 19348 |
Second Address | West Grove, PA 19390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2011 |
Last Update Date | 30/09/2011 |