Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1730126442 |
---|---|
Provider Name | Mr. Benjamen Scott Chancey |
First Address | Lake City, FL 32024-4159 |
Second Address | Lake City, FL 32025-5808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |