Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 02831 | KY |
NPI | 1073659488 |
---|---|
Provider Name | Mr. Daniel Brent Cross |
First Address | Crestview Hills, KY 41017-3421 |
Second Address | Crestview Hills, KY 41017-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 04/06/2020 |