Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3678 | SC |
NPI | 1003354770 |
---|---|
Provider Name | Emily Ross |
First Address | Simpsonville, SC 29681-5860 |
Second Address | Simpsonville, SC 29681-5860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2017 |
Last Update Date | 02/02/2017 |