Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA-6845 | MS |
NPI | 1013547223 |
---|---|
Provider Name | Alma Wollfarth |
First Address | Kosciusko, MS 39090-3620 |
Second Address | Kosciusko, MS 39090-3849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2020 |
Last Update Date | 15/09/2021 |