Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1374 |
NPI | 1790725414 |
---|---|
Provider Name | Mr. Richard Keith Smithdeal |
First Address | Elizabethton, TN 37643-5967 |
Second Address | Moutain Home, TN 37684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |