Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 6273 | CO |
NPI | 1255501961 |
---|---|
Provider Name | Mr. Patrick Naylor |
First Address | Boulder, CO 80304-3979 |
Second Address | Boulder, CO 80304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 10/03/2008 |