Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06002750A | IN |
NPI | 1003140757 |
---|---|
Provider Name | Amy Mcconnell |
First Address | Carmel, IN 46032 |
Second Address | Carmel, IN 46032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 29/09/2009 |