Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2017021415 | MO |
NPI | 1467973412 |
---|---|
Provider Name | Thomas Hargrave |
First Address | Blue Springs, MO 64015-3479 |
Second Address | Independence, MO 64057-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 29/06/2017 |