Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1154525616 |
---|---|
Provider Name | Mr. John Toby Imm |
First Address | Pensacola, FL 32502-5629 |
Second Address | Pensacola, FL 32502-5629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |