Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 018241-1 | NY |
NPI | 1013166982 |
---|---|
Provider Name | Heather Ann Vicari |
First Address | Poughkeepsie, NY 12603-5678 |
Second Address | Poughkeepsie, NY 12603-5678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 15/09/2008 |