Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 004475-1 | NY |
NPI | 1013376870 |
---|---|
Provider Name | Bonnie Flansburg |
First Address | Castorland, NY 13620 |
Second Address | Rome, NY 13440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2016 |
Last Update Date | 22/02/2016 |