Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P92699 | NY |
NPI | 1013327402 |
---|---|
Provider Name | Christina Hallford-Moynihan |
First Address | Oswego, NY 13126-2045 |
Second Address | Oswego, NY 13126-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 06/05/2014 |