Individual
BANNECKER BAXTER WOODS
Active
Individual
BANNECKER BAXTER WOODS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1329453
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1329453
STATE LICENSE
TX
Enumeration date
04/02/2020
Last updated
05/12/2020
Update your record
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