Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 005058 | IA |
NPI | 1033462783 |
---|---|
Provider Name | Bridget Epperson |
First Address | Council Bluffs, IA 51503-5275 |
Second Address | Council Bluffs, IA 51503-5275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 29/10/2012 |