Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 6683 | AZ |
NPI | 1093091118 |
---|---|
Provider Name | Hilda Lood |
First Address | Mesa, AZ 85206-6600 |
Second Address | Mesa, AZ 85206-4716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |