Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT008787L | PA |
NPI | 1043267230 |
---|---|
Provider Name | Jeannette Bongiovi |
First Address | Lewisburg, PA 17837-2800 |
Second Address | Lewisburg, PA 17837-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |