Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1645 | MS |
NPI | 1790995264 |
---|---|
Provider Name | Jessica Dawn Fielder |
First Address | Flowood, MS 39232 |
Second Address | Flowood, MS 39232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |