Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT-0844 | WY |
NPI | 1346571882 |
---|---|
Provider Name | Mr. James Eric Klaassen |
First Address | Gillette, WY 82718-8508 |
Second Address | Wright, WY 82732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2010 |
Last Update Date | 04/12/2015 |