Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE002121L | PA |
NPI | 1013031251 |
---|---|
Provider Name | Beth Dienno |
First Address | Folsom, PA 19033-2407 |
Second Address | Media, PA 19063-4422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |