Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 91522662401 | UT |
Y | 2251H1200X | Hand | 043092 | NY |
NPI | 1972999761 |
---|---|
Provider Name | Amy Washburn |
First Address | Rochester, NY 14608-2427 |
Second Address | Rochester, NY 14626-4296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 04/12/2019 |