Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A3808 | MD |
NPI | 1013266170 |
---|---|
Provider Name | Mr. George Glenn France JR. |
First Address | Baltimore, MD 21211-2040 |
Second Address | Riverdale, MD 20737-1058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 06/09/2012 |