Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | P12283 | NC |
NPI | 1063642353 |
---|---|
Provider Name | Mr. Kevin Michael Raymond |
First Address | Morrisville, NC 27560-8442 |
Second Address | Cary, NC 27518-7413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 09/08/2021 |