Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT 4746 | FL |
NPI | 1265578884 |
---|---|
Provider Name | Mr. Rettig W. Talbot |
First Address | Boynton Beach, FL 33437-6154 |
Second Address | Boynton Beach, FL 33437-6154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 30/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00450774 | MEDICARE RAIL ROAD (01) | FL |