Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 032790 | NY |
NPI | 1023320462 |
---|---|
Provider Name | Amy Colin |
First Address | Fairport, NY 14450-1434 |
Second Address | Fairport, NY 14450-1434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 24/08/2010 |