Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2000170884 | MO |
NPI | 1043383920 |
---|---|
Provider Name | Amelia Cierpiot |
First Address | Independence, MO 64050-3650 |
Second Address | Independence, MO 64050-3650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34740011 | BLUE CROSS BLUE SHIELD IN (01) | MO |