Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 9689 | MN |
Y | 2251X0800X | Physical Therapist - Orthopedic | 9689 | MN |
NPI | 1063811552 |
---|---|
Provider Name | Alisse Zignego |
First Address | Maplewood, MN 55109-1320 |
Second Address | Maplewood, MN 55109-1244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 31/03/2020 |