Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT02258 | RI |
NPI | 1063788438 |
---|---|
Provider Name | Elena Kim Perez |
First Address | Providence, RI 02905-3230 |
Second Address | Providence, RI 02905-3230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 30/03/2012 |