Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 21455 | MD |
NPI | 1013428242 |
---|---|
Provider Name | Cynthia Spooner |
First Address | Apo, AE 09603-0035 |
Second Address | Apo, AE 09604-6180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2017 |
Last Update Date | 16/10/2017 |