Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160001470 | IL |
NPI | 1003123522 |
---|---|
Provider Name | Fonda Sharkey-Wyatt |
First Address | Salem, NH 03079-2839 |
Second Address | Salem, NH 03079-2839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 03/09/2010 |