Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 002102 | KY |
NPI | 1053850925 |
---|---|
Provider Name | Gina Shields New |
First Address | Fort Thomas, KY 41075-1022 |
Second Address | Covington, KY 41011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2017 |
Last Update Date | 13/02/2017 |