Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 00002579 | WA |
NPI | 1063759447 |
---|---|
Provider Name | Gloria Jean Andrus |
First Address | Sequim, WA 98382-3045 |
Second Address | Sequim, WA 98382-3045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2013 |
Last Update Date | 06/01/2013 |