Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE1003359 | PA |
NPI | 1013418870 |
---|---|
Provider Name | Diane D Janiec |
First Address | West Chester, PA 19380-5918 |
Second Address | Christiana, PA 17509-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |