Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1275633240 |
---|---|
Provider Name | Mr. Eugene R. Bakenhester |
First Address | Seminole, FL 33776 |
Second Address | Bay Pines, FL 33744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |