Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1198880 | TX |
NPI | 1093131914 |
---|---|
Provider Name | Dr. Amber Leigh Krumholtz |
First Address | Fort Worth, TX 76244-9405 |
Second Address | Fort Worth, TX 76244-9405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2014 |
Last Update Date | 16/03/2014 |