Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 17979 | NC |
NPI | 1063905065 |
---|---|
Provider Name | Gabriela Perez |
First Address | Raleigh, NC 27609-3814 |
Second Address | Raleigh, NC 27609-3814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |