Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306603919 | VA |
NPI | 1003216938 |
---|---|
Provider Name | Desiree Stannard |
First Address | Mechanicsville, VA 23111 |
Second Address | Mechanicsville, VA 23111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2014 |
Last Update Date | 28/08/2014 |