Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | TE001660L | PA |
Y | 225200000X | Physical Therapy Assistant | TEI000571 | PA |
NPI | 1013138890 |
---|---|
Provider Name | Mr. Harry Lee Kerstetter JR. |
First Address | Sunbury, PA 17801-6209 |
Second Address | Orangeville, PA 17859-9064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 27/08/2010 |