Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT03589 | OH |
NPI | 1053315911 |
---|---|
Provider Name | Mr. Charles P Conti |
First Address | Milford, OH 45150-6566 |
Second Address | Cincinnati, OH 45242-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10939239 | (05) | OH |