Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 2011 | MS |
NPI | 1871247858 |
---|---|
Provider Name | Mr. Ja'gradi Webster |
First Address | Biloxi, MS 39531-2410 |
Second Address | Biloxi, MS 39531-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2022 |
Last Update Date | 08/02/2022 |