Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 000224-1 | NY |
NPI | 1013314798 |
---|---|
Provider Name | Anne Farrell |
First Address | Oswego, NY 13126-2045 |
Second Address | Oswego, NY 13126-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2014 |
Last Update Date | 25/11/2014 |