Doctor Name: | DOUGLAS JAMES PRIMM |
NPI Number: | 1699156752 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT/PTA |
License Number: | 11169-N-R |
Business Practice Address: | 4488 W Broad St Ste 100 Columbus, OH - 432285610 |
Business Phone Number: | 6148514442 |
Business Fax Number: | |
Mailing Address: | 4488 W Broad St Ste 100, COLUMBUS |
State: | OH |
Postal Code: | 432285610 |
Phone Number: | 6148514442 |
Fax Number: | |
NPI Enumeration Date: | 06/15/2015 |
NPI Last Update Date: | 06/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 11169-N-R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |