Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1812 | MS |
NPI | 1528400884 |
---|---|
Provider Name | Mr. Russell Barmer |
First Address | Shreveport, LA 71101-4243 |
Second Address | Shreveport, LA 71101-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 26/07/2013 |