Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 003758 | KY |
Y | 2251P0200X | Physical Therapist - Pediatrics | 003758 | KY |
NPI | 1336667690 |
---|---|
Provider Name | Mr. Anthony Shawn Prater |
First Address | Lexington, KY 40502 |
Second Address | Lexington, KY 40502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 25/09/2017 |