Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2005029637 | MO |
NPI | 1013956093 |
---|---|
Provider Name | Elizabeth Jean Chiesa |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Blue Springs, MO 64014-3539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 20/03/2017 |