Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | MS |
NPI | 1669981189 |
---|---|
Provider Name | Mr. David Lebeau JR. |
First Address | Prescott Valley, AZ 86315-4004 |
Second Address | Prescott, AZ 86301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2017 |
Last Update Date | 27/09/2017 |