Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A01416 | KY |
NPI | 1013100932 |
---|---|
Provider Name | Mr. Jonathan Joseph Eisenhauer |
First Address | Hopkinsville, KY 42240 |
Second Address | Hopkinsville, KY 42240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 23/08/2007 |