Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE010994 | PA |
NPI | 1003358383 |
---|---|
Provider Name | Jessica Fox |
First Address | Meadville, PA 16335-5559 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2016 |
Last Update Date | 17/11/2016 |