Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 010442 | NY |
NPI | 1003387192 |
---|---|
Provider Name | Mr. Tai Luong La |
First Address | Brooklyn, NY 11214 |
Second Address | Brooklyn, NY 11204-6079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |