Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 005648-1 | NY |
NPI | 1104075258 |
---|---|
Provider Name | Diane Marie Morrison |
First Address | Lagrangeville, NY 12540-6229 |
Second Address | Lagrangeville, NY 12540-6229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2008 |
Last Update Date | 13/09/2008 |