Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0004983 | CO |
NPI | 1003232703 |
---|---|
Provider Name | Murray Thiessen |
First Address | Grand Junction, CO 81501-8209 |
Second Address | Grand Junction, CO 81501-8209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 05/03/2014 |