Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1013519024 |
---|---|
Provider Name | Christina Lauren Bovell |
First Address | Collegedale, TN 37315-1777 |
Second Address | Clarksville, TN 37043-1896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2020 |
Last Update Date | 13/11/2020 |