Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 6990 | AZ |
N | 2251P0200X | Physical Therapist - Pediatrics | 6990 | AZ |
NPI | 1104039791 |
---|---|
Provider Name | Anna Fern-Buneo |
First Address | Mesa, AZ 85206-2148 |
Second Address | Mesa, AZ 85206-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
968068 | (05) | AZ |