Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 005613 | KY |
NPI | 1003137928 |
---|---|
Provider Name | Ryan Kizer |
First Address | Owensboro, KY 42303-3564 |
Second Address | Owensboro, KY 42303-3564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 15/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11903135 | (05) | KY |
184517 | MEDICARE (01) | |
33000035 | (05) | KY |
45118379 | (05) | KY |