Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 05012456A | IN |
NPI | 1053833871 |
---|---|
Provider Name | Cassandra Ann Meyers |
First Address | Avon, IN 46123-8167 |
Second Address | Crown Point, IN 46307-7474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 13/07/2017 |