Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1962502609 |
---|---|
Provider Name | Mr. Michael D Kuziola |
First Address | Gray, TN 37615-4272 |
Second Address | Mountain Home, TN 37684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 08/07/2007 |