Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1120434 | TX |
NPI | 1003985995 |
---|---|
Provider Name | Carrie E Self |
First Address | Montgomery, TX 77356-1808 |
Second Address | Montgomery, TX 77356-1808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |