Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1184340 | TX |
NPI | 1134356769 |
---|---|
Provider Name | Brooke Ann Pace |
First Address | Amarillo, TX 79106-1741 |
Second Address | Amarillo, TX 79106-1741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 22/06/2009 |