Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00008236 | WA |
NPI | 1003280538 |
---|---|
Provider Name | Mr. Jonas Cline |
First Address | Edgewood, WA 98372-2096 |
Second Address | Puyallup, WA 98372-6774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2015 |
Last Update Date | 20/11/2015 |