Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3467 | MA |
NPI | 1003055682 |
---|---|
Provider Name | Debra Barron |
First Address | Phoenix, AZ 85021-7967 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2009 |
Last Update Date | 05/02/2009 |