Individual
MR. DENNIS ALAN SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
321 E 11TH ST, JONESBORO, IN 46938-1618
(765) 618-8047
(765) 674-9491
Mailing address
321 E 11TH ST, JONESBORO, IN 46938-1618
(765) 618-8047
(765) 674-9491
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002277A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470
PHYSICAL THERAPIST ASST.
IN
Enumeration date
04/19/2007
Last updated
07/08/2007
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