Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1267 | NE |
NPI | 1013332550 |
---|---|
Provider Name | Mr. Nathaniel Jones |
First Address | Grand Island, NE 68801 |
Second Address | Grand Island, NE 68801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2014 |
Last Update Date | 20/02/2014 |