Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1809 | TN |
N | 2251G0304X | Physical Therapist - Geriatrics | 1809 | TN |
NPI | 1164640215 |
---|---|
Provider Name | Mr. John Henry Gassler III |
First Address | Murfreesboro, TN 37129-5209 |
Second Address | Murfreesboro, TN 37129-1545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1809 | MEDICAL LICENSE (01) | TN |