Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1198162 | TX |
NPI | 1023434842 |
---|---|
Provider Name | Amanda Foresman |
First Address | Dallas, TX 75212-6313 |
Second Address | Dallas, TX 75212-6313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2014 |
Last Update Date | 18/03/2014 |