Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1871601237 |
---|---|
Provider Name | Mr. Robert A Smith |
First Address | Rockland, MA 02370-2401 |
Second Address | Brockton, MA 02301-5596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 08/07/2007 |