Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1595 | VA |
NPI | 1366479016 |
---|---|
Provider Name | Mr. Stephen Scott Pittman |
First Address | Newport News, VA 23601-3714 |
Second Address | Newport News, VA 23601-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1575 | AMERICAN KINESIOTHERAPY R (01) | VA |