Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT015043 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT015043 | PA |
NPI | 1083683072 |
---|---|
Provider Name | William M Dewire |
First Address | Lewisburg, PA 17837-2800 |
Second Address | Lewisburg, PA 17837-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |