Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 7384 | TN |
Y | 2251X0800X | Physical Therapist - Orthopedic | 5853 | AL |
NPI | 1043234784 |
---|---|
Provider Name | Mr. Trent Nessler |
First Address | Birmingham, AL 35205-1636 |
Second Address | Birmingham, AL 35205-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 02/08/2010 |