Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 11-03913 | KS |
Y | 225100000X | Physical Therapist | 11321 | AZ |
N | 225100000X | Physical Therapist | 5501013178 | MI |
NPI | 1003315110 |
---|---|
Provider Name | Tarang Kumar Jain |
First Address | Flagstaff, AZ 86004-9567 |
Second Address | Flagstaff, AZ 86011-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2018 |
Last Update Date | 03/02/2018 |