Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT02556 | RI |
N | 225200000X | Physical Therapy Assistant | PTA00835 | RI |
NPI | 1013293281 |
---|---|
Provider Name | Alejandra Calderon |
First Address | Providence, RI 02905 |
Second Address | Providence, RI 02905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2011 |
Last Update Date | 25/03/2013 |