Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305203355 | VA |
NPI | 1063665362 |
---|---|
Provider Name | Allison Marie Elegbe |
First Address | Herndon, VA 20171-1521 |
Second Address | Stafford, VA 22554-8331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 31/08/2017 |