Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 10982 | CA |
NPI | 1013393263 |
---|---|
Provider Name | Mr. Kyle James Bessey |
First Address | Willows, CA 95988-3144 |
Second Address | Orland, CA 95963-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2015 |
Last Update Date | 10/08/2015 |