Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5634 | TN |
NPI | 1003909110 |
---|---|
Provider Name | Mr. Kenneth Woodruff |
First Address | Knoxville, TN 37923-4605 |
Second Address | Knoxville, TN 37923-4605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 27/07/2007 |