Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1152931 | TX |
NPI | 1134279367 |
---|---|
Provider Name | Jaime Anderson |
First Address | Temple, TX 76502-5127 |
Second Address | Killeen, TX 76542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |