Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 00002290 | WA |
NPI | 1255780961 |
---|---|
Provider Name | Mr. Kenneth James Overman |
First Address | Arlington, WA 98223-7973 |
Second Address | Arlington, WA 98223-7973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 03/06/2016 |