Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7955 | AZ |
NPI | 1003089384 |
---|---|
Provider Name | Deborah A Mordhorst |
First Address | Charlotte, NC 28217-4580 |
Second Address | Mesa, AZ 85212-2164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7955 | AZ LICENSE (01) | AZ |