Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21217 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | PT21217 | FL |
N | 2251H1200X | Hand | PT21217 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PT21217 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | PT21217 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT21217 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT21217 | FL |
NPI | 1619042298 |
---|---|
Provider Name | Mr. Yonel Bredy JR. |
First Address | Matthews, NC 28105-4176 |
Second Address | Matthews, NC 28105-4176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016964700 | (05) | FL |
017306900 | (05) | FL |
IN970A | (02) | FL |
U8857Y | (02) | FL |