Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1263255 | TX |
NPI | 1003315029 |
---|---|
Provider Name | Jessica Silveira |
First Address | Austin, TX 78758-5260 |
Second Address | Austin, TX 78758-5260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 05/02/2018 |