Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1057388 | TX |
NPI | 1376582973 |
---|---|
Provider Name | W Gordon Eiland |
First Address | Tyler, TX 75703 |
Second Address | Tyler, TX 75703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 01/07/2011 |