Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0000004501 | TN |
NPI | 1013203629 |
---|---|
Provider Name | Mr. Stephen Lyle Archer |
First Address | Greeneville, TN 37745-3098 |
Second Address | Greeneville, TN 37745-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 22/06/2011 |