Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1257 | IA |
NPI | 1588610810 |
---|---|
Provider Name | Mr. Michael Harold Christian |
First Address | Tracy, IA 50256-8550 |
Second Address | Knoxville, IA 50138-3354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |