Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1194763391 |
---|---|
Provider Name | Mr. John R Wolcott |
First Address | Wilkes Barre, PA 18711-0030 |
Second Address | Wilkes Barre, PA 18711-0030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |