Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 032639 | NY |
NPI | 1003128562 |
---|---|
Provider Name | Allysyn Marie O'connell |
First Address | Lima, NY 14485-9741 |
Second Address | Victor, NY 14564-9744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 04/03/2020 |