Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTH4967 | AL |
NPI | 1003017187 |
---|---|
Provider Name | Roger Keith Gurley |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Cullman, AL 35055-5547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 09/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003017187 | INDIVIDUAL NPI (01) | AL |