Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305211970 | VA |
NPI | 1033678941 |
---|---|
Provider Name | Annie Golovcsenko |
First Address | Lexington, MA 02421-6113 |
Second Address | Centreville, VA 20121-2437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2019 |
Last Update Date | 19/03/2019 |