Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 05003754 A | IN |
N | 2251G0304X | Physical Therapist - Geriatrics | 5501015012 | MI |
N | 2251N0400X | Physical Therapist - Neurology | 05003754 A | IN |
N | 2251N0400X | Physical Therapist - Neurology | 5501015012 | MI |
N | 2251S0007X | Physical Therapist - Sports | 5501015012 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 05003754 A | IN |
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501015012 | MI |
NPI | 1316092273 |
---|---|
Provider Name | Mr. Gerald Espiritu |
First Address | Mishawaka, IN 46545-1863 |
Second Address | Benton Harbor, MI 49022-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 25/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MI 2570001 | MEDICARE PTAN (01) | MI |