Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305211168 | VA |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1407408206 |
---|---|
Provider Name | Dr. Katelyn Paige St.clair |
First Address | Richmond, VA 23220-5207 |
Second Address | Mechanicsville, VA 23116-1844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2305211168 | BOARD OF PHYSICAL THERAPY (01) | VA |