Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1346134 | TX |
NPI | 1013582360 |
---|---|
Provider Name | Ryan Allen Baumgartner |
First Address | Rowlett, TX 75088-6759 |
Second Address | Carrollton, TX 75006-6904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2021 |
Last Update Date | 20/05/2021 |