| Name | Value |
|---|---|
| PROVIDER TYPE | Respiratory, Rehabilitative and Restorative Service |
| CLASSIFICATION | Respiratory Therapist |
| STATUS | Inactive |
| DATE INACTIVATED | 2018-04-02 00:00:00 |
| VA CODE | V130508 |
| X12 CODE | 225900000N |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255402 |
| EFFECTIVE DATE/TIME |
|