Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2005036213 | MO |
NPI | 1003146804 |
---|---|
Provider Name | Haziel E Perlada |
First Address | Warsaw, MO 65355-3059 |
Second Address | Pelham, AL 35124-2216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2009 |
Last Update Date | 30/12/2009 |