Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 376 | MT |
NPI | 1386890507 |
---|---|
Provider Name | Mr. John Lewis |
First Address | Great Falls, MT 59405-5201 |
Second Address | Great Falls, MT 59405-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 08/08/2008 |