Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist |
NPI | 1851359582 |
---|---|
Provider Name | Miss Jimmy L. Darby |
First Address | Ellisville, MS 39437-2713 |
Second Address | Ellisville, MS 39437-2713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |