Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 24064 | MD |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305209066 | VA |
NPI | 1073878203 |
---|---|
Provider Name | Elizabeth Abbey Lynn Andrulewicz |
First Address | Fairfax, VA 22030-6078 |
Second Address | Aberdeen, MD 21001-1762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 13/10/2014 |