Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P161035801 | WA |
NPI | 1003421843 |
---|---|
Provider Name | Anita M Terranova |
First Address | Bremerton, WA 98312-3524 |
Second Address | Bremerton, WA 98312-3524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2020 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P161035801 | STATE LICENSE (01) | WA |