Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2119471 | TX |
NPI | 1013442326 |
---|---|
Provider Name | Irene Alba |
First Address | Fort Worth, TX 76131-1625 |
Second Address | Fort Worth, TX 76131-1625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 24/04/2017 |