Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 022838 | PA |
NPI | 1013341619 |
---|---|
Provider Name | Mr. John Edward Jemison |
First Address | Islandia, NY 11749-5258 |
Second Address | Newtown, PA 18940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 24/07/2017 |