Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60578159 | WA |
NPI | 1003283565 |
---|---|
Provider Name | Adriana Luz Gonzalez-Medina |
First Address | Bainbridge Island, WA 98110-0276 |
Second Address | Bainbridge Island, WA 98110-1769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 31/08/2015 |