Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 034474 | NY |
Y | 2251S0007X | Physical Therapist - Sports | LPT-31803 | AZ |
NPI | 1245586817 |
---|---|
Provider Name | Mr. John Edward Ebinger |
First Address | Phoenix, AZ 85022-2254 |
Second Address | Tempe, AZ 85284-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2012 |
Last Update Date | 28/12/2021 |