Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 042148 | NY |
NPI | 1346769858 |
---|---|
Provider Name | Raymond Shu |
First Address | Kenmore, NY 14223 |
Second Address | Kenmore, NY 14223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 11/03/2020 |