Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1378 |
NPI | 1619920840 |
---|---|
Provider Name | Mr. Michael R Engle |
First Address | Lake City, FL 32025-1778 |
Second Address | Lake City, FL 32025-5808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 13/10/2021 |