Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1095 | SD |
NPI | 1043540032 |
---|---|
Provider Name | Mr. Andy York |
First Address | Watertown, SD 57201-5815 |
Second Address | Watertown, SD 57201-4316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 13/01/2010 |