Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT2347 | ME |
NPI | 1093915274 |
---|---|
Provider Name | Emily Avery |
First Address | Lewiston, ME 04240-3545 |
Second Address | Lewiston, ME 04240-3545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 25/07/2007 |