Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 120479 | AZ |
NPI | 1225699176 |
---|---|
Provider Name | Ashley Hicks Staffa |
First Address | Glendale, AZ 85308-8389 |
Second Address | Glendale, AZ 85308-8389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2019 |
Last Update Date | 21/06/2019 |