Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-02082 | KS |
NPI | 1013224039 |
---|---|
Provider Name | Mr. Michael Leroy Vinyard |
First Address | Lawrence, KS 66049 |
Second Address | Baldwin City, KS 66006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 13/09/2010 |