Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1264195 | TX |
NPI | 1124655345 |
---|---|
Provider Name | Amanda M Meusborn |
First Address | Flower Mound, TX 75028-1292 |
Second Address | Anna, TX 75409-8459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |