Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1558750224 |
---|---|
Provider Name | Gina Fick |
First Address | Lewisburg, PA 17837-1564 |
Second Address | Lewisburg, PA 17837-1564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2015 |
Last Update Date | 05/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
738494000 | MEDICARE PROVIDER NUMBER (01) | PA |