Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3980 | NC |
N | 2251G0304X | Physical Therapist - Geriatrics | 5399 | NC |
NPI | 1245438902 |
---|---|
Provider Name | Thomas Nelson Teixeira |
First Address | Shallotte, NC 28470-8117 |
Second Address | Shallotte, NC 28470-8117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2007 |
Last Update Date | 08/07/2007 |