Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2248 | SC |
NPI | 1003154527 |
---|---|
Provider Name | Jessica Dean |
First Address | Charleston, SC 29414-9022 |
Second Address | San Diego, CA 92130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 17/01/2013 |