Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 209153 | TX |
NPI | 1205317286 |
---|---|
Provider Name | Felicia Youngblood |
First Address | Cedar Hill, TX 75104-7341 |
Second Address | Dallas,, TX 75238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |