Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ||
Y | 225000000X | Orthotic Fitter | NC |
NPI | 1962701011 |
---|---|
Provider Name | Van Truman Clontz |
First Address | Morganton, NC 28655-3866 |
Second Address | Morganton, NC 28655-3866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2011 |
Last Update Date | 15/03/2011 |