Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 10013 | NC |
NPI | 1104342260 |
---|---|
Provider Name | Donna Misa |
First Address | Raleigh, NC 27616-5977 |
Second Address | Raleigh, NC 27616-5977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2017 |
Last Update Date | 20/08/2017 |