Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1328042 | TX |
NPI | 1285266965 |
---|---|
Provider Name | Amanda Rose Richter Mccreight |
First Address | Euless, TX 76039-5732 |
Second Address | Fort Worth, TX 76104-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2020 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1328042 | LICENSE NUMBER (01) | TX |