Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 22077702 | TX |
Y | 225200000X | Physical Therapy Assistant | 5502001711 | MI |
NPI | 1003117748 |
---|---|
Provider Name | Diana Kamal Osman |
First Address | Fenton, MI 48430-9717 |
Second Address | Waterford, MI 48329-3451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2010 |
Last Update Date | 11/11/2010 |