Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2040152 | TX |
NPI | 1376026617 |
---|---|
Provider Name | Genise Nicole Perkins |
First Address | Mansfield, TX 76063-9057 |
Second Address | Arlington, TX 76002-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2018 |
Last Update Date | 12/09/2018 |