Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 09873 | OH |
NPI | 1396361572 |
---|---|
Provider Name | Emily Stanton |
First Address | Springfield, OH 45503-3658 |
Second Address | Springfield, OH 45503-3658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2020 |
Last Update Date | 23/06/2020 |