Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 40QB00141600 | NJ |
NPI | 1992998116 |
---|---|
Provider Name | Mr. David Lilburn Mcglothlen |
First Address | Dallas, TX 75201-3801 |
Second Address | Voorhees, NJ 08043-9547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 21/08/2007 |