Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | P11339 | NC |
NPI | 1023290079 |
---|---|
Provider Name | Sean Thomas Nixon |
First Address | Fuquay Varina, NC 27526-7263 |
Second Address | Fuquay Varina, NC 27526-7263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2007 |
Last Update Date | 19/02/2010 |