Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1023119401 |
---|---|
Provider Name | Mr. Harold Jackson Delotelle JR. |
First Address | Beavercreek, OH 45434-7089 |
Second Address | Dayton, OH 45428-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |