Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1316533813 |
---|---|
Provider Name | Elizabeth Jones |
First Address | Camillus, NY 13031-4307 |
Second Address | Amherst, NY 14226-3544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2020 |
Last Update Date | 18/12/2020 |