Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT019436 | PA |
N | 2251S0007X | Physical Therapist - Sports | PT019436 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT019436 | PA |
NPI | 1003078544 |
---|---|
Provider Name | Christina R Mitman |
First Address | Boston, MA 02284-8269 |
Second Address | Allentown, PA 18104-9168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 31/07/2009 |