Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 63.001145 | CT |
NPI | 1013454222 |
---|---|
Provider Name | Benita Estime |
First Address | Norwalk, CT 06850-3501 |
Second Address | Norwalk, CT 06850-3501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2017 |
Last Update Date | 25/01/2017 |