Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 046723 | NY |
Y | 2251S0007X | Physical Therapist - Sports | PT300183 | CA |
NPI | 1184292617 |
---|---|
Provider Name | Dr. Ellen Merchant |
First Address | San Francisco, CA 94115-2511 |
Second Address | San Francisco, CA 94104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |