Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | A00482 | KY |
NPI | 1356505416 |
---|---|
Provider Name | Tom Mcginnis |
First Address | Louisville, KY 40222-6308 |
Second Address | Louisville, KY 40222-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 17/07/2008 |