Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 62038072 | NY |
NPI | 1003215450 |
---|---|
Provider Name | Dr. Liane Brown |
First Address | North Syracuse, NY 13212-1644 |
Second Address | North Syracuse, NY 13212-1644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2014 |
Last Update Date | 30/09/2016 |