Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053759712 |
---|---|
Provider Name | William Thomas Church |
First Address | Carson City, NV 89701-4730 |
Second Address | Carson City, NV 89701-4730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 19/06/2013 |