Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1433 | IL |
NPI | 1093954364 |
---|---|
Provider Name | Mr. Craig Phillip Gobich |
First Address | Bowling Green, KY 42104-7462 |
Second Address | Murfreesboro, TN 37129-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 10/02/2009 |