| NPI | 1104498369 |
|---|---|
| Former Name | BRADLEY DEJARNETTE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10649) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-10-29 |