Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1318379 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1318379 | TX |
NPI | 1598315699 |
---|---|
Provider Name | Dr. Autumn Hardin |
First Address | Beaumont, TX 77706-6850 |
Second Address | Beaumont, TX 77706-6850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 17/08/2020 |