Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 084252 | IA |
NPI | 1013434349 |
---|---|
Provider Name | Erin Kaitlyn Johnson |
First Address | Waverly, IA 50677-3775 |
Second Address | Waverly, IA 50677-2619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2017 |
Last Update Date | 28/08/2017 |