Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 582 | OH |
NPI | 1437247681 |
---|---|
Provider Name | Mr. Robert Alan Ripley |
First Address | Hewitt, TX 76643-3425 |
Second Address | Waco, TX 76711-1329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
582 | KINESIOTHERAPIST (01) | TX |