Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1112969 | TX |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1073807731 |
---|---|
Provider Name | Dershie Bridgford Kurtz |
First Address | Boerne, TX 78006-8260 |
Second Address | Boerne, TX 78006-8260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2011 |
Last Update Date | 30/05/2011 |