Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013256478 |
---|---|
Provider Name | Mr. Christian Bernau |
First Address | Galveston, TX 77554 |
Second Address | Galveston, TX 77554-7119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 05/02/2013 |