Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT 60277344 | WA |
NPI | 1700236080 |
---|---|
Provider Name | Mr. Nathan Allen Coomer |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 01/09/2016 |