Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305205156 | VA |
NPI | 1003095449 |
---|---|
Provider Name | Aryn Carlson IX |
First Address | Richmond, VA 23227-4347 |
Second Address | Richmond, VA 23227-4347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2007 |
Last Update Date | 02/11/2007 |