Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | PT002739L | PA |
NPI | 1083795447 |
---|---|
Provider Name | Mr. Paul Gregory Slocum |
First Address | Plains, PA 18702 |
Second Address | Plains, PA 18702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1918181 | BLUE SHIELD (01) | |
820864 | FIRST PRIORITY (01) | |
821142 | FIRST PRIORITY (01) |