Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 904 | NC |
NPI | 1093781403 |
---|---|
Provider Name | Mr. Frank J Hielema |
First Address | Raleigh, NC 27608-2308 |
Second Address | Raleigh, NC 27608-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0786T | BLUE CROSS BLUE SHIELD (01) | NC |
7210586 | (05) | NC |