Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 010783 | OH |
NPI | 1154633931 |
---|---|
Provider Name | Aila Mella |
First Address | Wyoming, OH 45215 |
Second Address | Wyoming, OH 45215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 08/07/2010 |