Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2100146 | TX |
NPI | 1003202789 |
---|---|
Provider Name | Robbie Lee Balthrop |
First Address | Sherman, TX 75092-3106 |
Second Address | Sherman, TX 75092-3106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 09/04/2015 |