Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306605566 | VA |
NPI | 1013503226 |
---|---|
Provider Name | Iyonna Eppes |
First Address | Chesterfield, VA 23832-6969 |
Second Address | North Chesterfield, VA 23235-3505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2020 |
Last Update Date | 13/12/2020 |