Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P1 60516094 | WA |
NPI | 1003209099 |
---|---|
Provider Name | Christena Runolfson |
First Address | Omaha, NE 68154-4407 |
Second Address | Omaha, NE 68154-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2015 |
Last Update Date | 15/03/2015 |