| NPI | 1588332563 |
|---|---|
| Former Name | CHAISE SEASHOLTZ |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106897) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2024-08-09 |