Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05007626A | IN |
Y | 2251C2600X | Cardiopulmonary | 05007626A | IN |
NPI | 1851816912 |
---|---|
Provider Name | Jessica James |
First Address | Indianapolis, IN 46202 |
Second Address | Indianapolis, IN 46202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2017 |
Last Update Date | 10/08/2017 |