Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1192720 | TX |
NPI | 1003184672 |
---|---|
Provider Name | Mr. Jeremy Mark Nelms |
First Address | Paris, TX 75462 |
Second Address | Paris, TX 75462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2011 |
Last Update Date | 18/07/2015 |