Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1352103 | TX |
NPI | 1083377493 |
---|---|
Provider Name | Seth W Gross |
First Address | Richardson, TX 75081-1864 |
Second Address | Richardson, TX 75081-1864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 21/10/2021 |