Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CPO02352 | NC |
NPI | 1306175161 |
---|---|
Provider Name | Mr. John Luther Rufty JR. |
First Address | Newton, NC 28658-1152 |
Second Address | Hickory, NC 28602-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 08/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795169 | (05) | NC |