Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 016410-1 | NY |
NPI | 1003076308 |
---|---|
Provider Name | Plamen Alexandrov |
First Address | Danville, IL 61832-5100 |
Second Address | Danville, IL 61832-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 11/06/2008 |