Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1099125 | TX |
NPI | 1003257460 |
---|---|
Provider Name | Jennifer G Classy |
First Address | Easton, PA 18040-7958 |
Second Address | San Antonio, TX 78258-4353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 15/07/2013 |