Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1568 | ND |
NPI | 1003105958 |
---|---|
Provider Name | Steven Isamu Panos |
First Address | Grand Forks, ND 58201-4032 |
Second Address | Grand Forks, ND 58201-4032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2011 |
Last Update Date | 31/03/2011 |