Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1407215106 |
---|---|
Provider Name | Jacquelyn Hale |
First Address | Columbus, GA 31909-9133 |
Second Address | Auburn, AL 36849-5419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2016 |
Last Update Date | 23/02/2016 |