Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60598621 | WA |
NPI | 1003274614 |
---|---|
Provider Name | Anna Hardesty |
First Address | Grand Coulee, WA 99133-8718 |
Second Address | Grand Coulee, WA 99133-8718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2055346 | (05) | WA |