Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 047124 | NY |
NPI | 1275101289 |
---|---|
Provider Name | Victor Uribe |
First Address | New York, NY 10011-7420 |
Second Address | New York, NY 10011-7420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |