Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TEI005368 | PA |
NPI | 1003424235 |
---|---|
Provider Name | Courtney Enck |
First Address | Quarryville, PA 17566-9143 |
Second Address | Quarryville, PA 17566-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |