Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2251G0304X | VT |
NPI | 1063887693 |
---|---|
Provider Name | Jacqueline Abella |
First Address | Saint Johnsbury, VT 05819-1035 |
Second Address | Saint Johnsbury, VT 05819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2015 |
Last Update Date | 08/12/2015 |