Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1121 | SD |
NPI | 1265624951 |
---|---|
Provider Name | Mr. Chris D Forred |
First Address | Groton, SD 57445-2172 |
Second Address | Groton, SD 57445-2172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 17/08/2007 |