Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 3918 | KY |
NPI | 1073778445 |
---|---|
Provider Name | Mr. Charles Workman |
First Address | Wilmore, KY 40390-1039 |
Second Address | Lexington, KY 40504-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 24/07/2008 |