Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305208949 | VA |
NPI | 1093111908 |
---|---|
Provider Name | Elizabeth Jackson Yanow |
First Address | Danville, VA 24540-2863 |
Second Address | Danville, VA 24540-2863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 14/11/2015 |