Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 2-3197 | TX |
NPI | 1558482141 |
---|---|
Provider Name | Dr. Therese Marie Adamiec |
First Address | Fort Worth, TX 76180-2611 |
Second Address | Fort Worth, TX 76180-2611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |