Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 902-019 | WI |
NPI | 1013189745 |
---|---|
Provider Name | Bridget C Boy |
First Address | Sheboygan, WI 53081-4237 |
Second Address | Sheboygan, WI 53081-4237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 27/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40461800 | (05) | WI |