Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1112480 | TX |
NPI | 1104173491 |
---|---|
Provider Name | Gracie Whitley |
First Address | Garland, TX 75041-3909 |
Second Address | Garland, TX 75041-3909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2012 |
Last Update Date | 06/08/2012 |