Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0288711 | NY |
NPI | 1003074865 |
---|---|
Provider Name | Alexandra Kirstin Grant |
First Address | Niagara Falls, NY 14301-1110 |
Second Address | Niagara Falls, NY 14301-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000530185001 | BLUE CROSS (01) | NY |
161608285 | NOVA (01) | NY |