Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 4863 | TX |
Y | 225100000X | Physical Therapist | 1079770 | TX |
NPI | 1356591176 |
---|---|
Provider Name | Dr. Vashtic Amma-Lesrine |
First Address | League City, TX 77573-5044 |
Second Address | League City, TX 77573-5044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 02/12/2008 |