Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 7874 | CA |
N | 2251E1200X | Ergonomics | 7874 | CA |
N | 225XE1200X | Ergonomics | 7874 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | 7874 | CA |
N | 2251S0007X | Physical Therapist - Sports | 7874 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 7874 | CA |
NPI | 1144332875 |
---|---|
Provider Name | Robert Bogdon Niklewicz |
First Address | Napa, CA 94558-2024 |
Second Address | Napa, CA 94558-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |