Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 12604 | NC |
NPI | 1003309758 |
---|---|
Provider Name | Janice Austria |
First Address | Clinton, NC 28328-4853 |
Second Address | Clinton, NC 28328-5002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |