Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1815 | MS |
NPI | 1548826514 |
---|---|
Provider Name | Mr. Dale Willie Mcghee JR. |
First Address | Biloxi, MS 39531-2410 |
Second Address | Pensacola, FL 32507-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2019 |
Last Update Date | 15/05/2019 |