Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT001937 | KY |
NPI | 1003151226 |
---|---|
Provider Name | Diane Marie Seibert |
First Address | Easton, PA 18040-7958 |
Second Address | Edgewood, KY 41017-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2012 |
Last Update Date | 28/11/2012 |