Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0291 | NV |
NPI | 1003078593 |
---|---|
Provider Name | Mr. Anthony Joseph Morella |
First Address | Henderson, NV 89014-3586 |
Second Address | Henderson, NV 89014-3586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 24/05/2011 |