Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1220079 | TX |
NPI | 1790314995 |
---|---|
Provider Name | Elizabeth Waldie |
First Address | Dallas, TX 75205-4455 |
Second Address | Dallas, TX 75235-7707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 08/04/2020 |