Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1922420744 |
---|---|
Provider Name | Randall Lewallen |
First Address | Salisbury, NC 28144-2515 |
Second Address | Salisbury, NC 28144-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2014 |
Last Update Date | 14/01/2014 |