Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT017727 | PA |
NPI | 1023149234 |
---|---|
Provider Name | Elizabeth Catherine Stephens Datorre |
First Address | Elizabethtown, PA 17022-1330 |
Second Address | Lancaster, PA 17603-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013950620001 | 17 (01) | PA |