Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1120 | AZ |
NPI | 1114086634 |
---|---|
Provider Name | Mr. Richard Stuart |
First Address | Cave Creek, AZ 85327-0426 |
Second Address | Scottsdale, AZ 85262-5243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
57655 | (05) | AZ |