Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5949 | AZ |
NPI | 1013042399 |
---|---|
Provider Name | Erica Goolsby |
First Address | Chandler, AZ 85224-6178 |
Second Address | Chandler, AZ 85224-6178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 14/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
740325 | (05) | AZ |