Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | NY |
NPI | 1962014605 |
---|---|
Provider Name | Ericka Johnson |
First Address | New York, NY 10035-0812 |
Second Address | New York, NY 10036-1818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2020 |
Last Update Date | 22/08/2020 |