Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 13626 | AZ |
Y | 225100000X | Physical Therapist | 24572 | MA |
NPI | 1003303611 |
---|---|
Provider Name | Jenna Plummer |
First Address | Melville, NY 11747-5002 |
Second Address | Middleboro, MA 02346-1859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 02/10/2019 |