Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3836 | NH |
NPI | 1003242579 |
---|---|
Provider Name | Cassie L Dorval |
First Address | Bristol, NH 03222-4548 |
Second Address | Bristol, NH 03222-4548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2013 |
Last Update Date | 17/09/2013 |