Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0911 | NH |
NPI | 1003115742 |
---|---|
Provider Name | Timm Gamgee |
First Address | Salem, NH 03079-2839 |
Second Address | Salem, NH 03079-2839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2011 |
Last Update Date | 21/03/2011 |