Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT004813 | OH |
NPI | 1003239799 |
---|---|
Provider Name | Hope Boren |
First Address | Pickerington, OH 43147-9266 |
Second Address | Reynoldsburg, OH 43068-2014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2014 |
Last Update Date | 30/01/2014 |