Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TEI002997 | PA |
NPI | 1003413659 |
---|---|
Provider Name | Ryan Mark Mcclintock |
First Address | Uniontown, PA 15401-8991 |
Second Address | Uniontown, PA 15401-8991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 07/10/2020 |