Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160640141 | WA |
NPI | 1003346586 |
---|---|
Provider Name | Emilee Brooke Gisler |
First Address | Colville, WA 99114-3143 |
Second Address | Colville, WA 99114-8676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 15/06/2017 |