Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 11-06700 | KS |
Y | 2251X0800X | Physical Therapist - Orthopedic | PTL.0013636 | CO |
NPI | 1003285537 |
---|---|
Provider Name | Alexandra Humphries |
First Address | Greeley, CO 80634-3207 |
Second Address | Derby, KS 67037-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 22/06/2021 |