Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2130027 | TX |
NPI | 1013470913 |
---|---|
Provider Name | Irene Downing |
First Address | Jermyn, TX 76459-5223 |
Second Address | Olney, TX 76374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2019 |
Last Update Date | 09/04/2019 |