Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1568 | VA |
NPI | 1487603023 |
---|---|
Provider Name | Wesley L Gwinn |
First Address | Salem, VA 24153-6404 |
Second Address | Salem, VA 24153-6404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 04/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1568 | AKTA REGISTRATION NUMBER (01) | VA |