Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10567 | CT |
NPI | 1003292673 |
---|---|
Provider Name | Jessica Rice |
First Address | Trumbull, CT 06611-3313 |
Second Address | Bridgeport, CT 06610-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2015 |
Last Update Date | 06/08/2015 |