Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT01767 | RI |
NPI | 1053394056 |
---|---|
Provider Name | Mr. Joshua Jon Stefanik |
First Address | Vacaville, CA 95687-4986 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |