Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | P10291 | NC |
NPI | 1043682263 |
---|---|
Provider Name | Angelica Caroy |
First Address | Gastonia, NC 28056-8384 |
Second Address | Gastonia, NC 28054-1749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2015 |
Last Update Date | 27/10/2015 |