Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT024751 | PA |
NPI | 1003285867 |
---|---|
Provider Name | Barbara M Ennis |
First Address | Richboro, PA 18954-1108 |
Second Address | Richboro, PA 18954-1108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2015 |
Last Update Date | 22/09/2015 |