Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 8503 | CO |
Y | 225100000X | Physical Therapist | PT028083 | PA |
NPI | 1003190067 |
---|---|
Provider Name | Mr. Michael Steven Wahoff |
First Address | Erie, PA 16510-2304 |
Second Address | Erie, PA 16510-2304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2011 |
Last Update Date | 08/10/2020 |