Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1187450 | TX |
NPI | 1003058108 |
---|---|
Provider Name | Elizabeth Brotherton |
First Address | San Antonio, TX 78261-2803 |
Second Address | San Antonio, TX 78216-5866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 13/04/2011 |