Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1126365 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1126365 | TX |
NPI | 1356439103 |
---|---|
Provider Name | Jennifer Christinaki Kish |
First Address | San Antonio, TX 78258-3462 |
Second Address | San Antonio, TX 78258-3462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 07/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
197595501 | (05) | TX |