Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1144095 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1144095 | TX |
NPI | 1013039205 |
---|---|
Provider Name | Jenny M. Park |
First Address | Austin, TX 78759-5295 |
Second Address | Austin, TX 78759-5295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 05/07/2013 |