Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 041.0111788 | VT |
N | 225200000X | Physical Therapy Assistant | 1197 | NH |
NPI | 1003282773 |
---|---|
Provider Name | Amy Mason |
First Address | Brattleboro, VT 05301-6551 |
Second Address | Brattleboro, VT 05301-6551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 18/08/2015 |