Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1255685293 |
---|---|
Provider Name | Mr. Jeremy Keith Page |
First Address | Richmond, VA 23221 |
Second Address | Richmond, VA 23221-1241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 30/10/2012 |