Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6937 | TN |
NPI | 1023465291 |
---|---|
Provider Name | Mr. Juan Ramon Quiles JR. |
First Address | Memphis, TN 38119-5631 |
Second Address | Memphis, TN 38127-8806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 18/05/2016 |