Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1811105562 |
---|---|
Provider Name | Mr. John Wright Crain |
First Address | North Little Rock, AR 72118-2341 |
Second Address | North Little Rock, AR 72118-2341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |