Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 01214 | IA |
Y | 2251E1200X | Ergonomics | 01214 | IA |
Y | 225XE1200X | Ergonomics | 01214 | IA |
NPI | 1972590370 |
---|---|
Provider Name | Mr. William A Fellows |
First Address | Des Moines, IA 50306-4907 |
Second Address | West Des Moines, IA 50266-8216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 20/11/2008 |