Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1194487298 |
---|---|
Provider Name | Alyssa Rae Brothers |
First Address | Evansville, IN 47720-1610 |
Second Address | Fort Wayne, IN 46825-4155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2021 |
Last Update Date | 06/10/2021 |