Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 12113 | TN |
N | 2251P0200X | Physical Therapist - Pediatrics | 121950 | TX |
NPI | 1093131971 |
---|---|
Provider Name | Jessica Minard |
First Address | Springfield, TN 37172-1637 |
Second Address | Springfield, TN 37172-2937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2014 |
Last Update Date | 08/01/2019 |