Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 005329 | IA |
N | 2251G0304X | Physical Therapist - Geriatrics | 005329 | IA |
NPI | 1164846036 |
---|---|
Provider Name | Carrie Lynn Tope |
First Address | Waverly, IA 50677-4389 |
Second Address | Waverly, IA 50677-4389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 12/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0665992 | (05) | IA |