Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0647 | AZ |
NPI | 1043424922 |
---|---|
Provider Name | Dorcas Sue Ciskowski |
First Address | Phoenix, AZ 85044-6835 |
Second Address | Phoenix, AZ 85044-6835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |