Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA00760600 | NJ |
NPI | 1003962382 |
---|---|
Provider Name | Mr. Michael Knox |
First Address | Ocean, NJ 07712-4567 |
Second Address | Ocean, NJ 07712-4567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 02/09/2008 |