Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | KY003172 | KY |
NPI | 1053407577 |
---|---|
Provider Name | Ericka D. Quesada |
First Address | Louisville, KY 40243 |
Second Address | Louisville, KY 40243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |