Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501010462 | MI |
NPI | 1124268404 |
---|---|
Provider Name | Mr. Richard Allen Klemmer |
First Address | Kalamazoo, MI 49009-4411 |
Second Address | Kalamazoo, MI 49009-4411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 14/12/2009 |