Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 6221 | TN |
NPI | 1013369560 |
---|---|
Provider Name | Eden Galvez |
First Address | Kingsport, TN 37664-3765 |
Second Address | Kingsport, TN 37660-4622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 08/07/2016 |