Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06004464A | IN |
N | 225200000X | Physical Therapy Assistant | 09159 | OR |
N | 225200000X | Physical Therapy Assistant | A03380 | KY |
NPI | 1003286568 |
---|---|
Provider Name | Brandi Grider |
First Address | New Castle, IN 47362-2523 |
Second Address | New Castle, IN 47362-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2015 |
Last Update Date | 28/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A03380 | PTA LICENSE (01) | KY |