Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5440 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 5440 | AZ |
N | 2251H1300X | Human Factors | 5440 | AZ |
N | 225XH1300X | Human Factors | 5440 | AZ |
N | 2251N0400X | Physical Therapist - Neurology | 5440 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 5440 | AZ |
NPI | 1407952435 |
---|---|
Provider Name | Mr. Jonathan Robert Pauly |
First Address | Chandler, AZ 85246-6854 |
Second Address | Chandler, AZ 85224-7216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 02/08/2021 |