Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 985 | NY |
NPI | 1225050602 |
---|---|
Provider Name | Mr. Paul David Whitten |
First Address | Evans, GA 30809-4843 |
Second Address | Augusta, GA 30904-6258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |