Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1912911132 |
---|---|
Provider Name | Mr. Keith - Smith |
First Address | Coatesville, PA 19320-2773 |
Second Address | Coatesville, PA 19320-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |