Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1288 | NC |
NPI | 1013175736 |
---|---|
Provider Name | Jessica Spruill |
First Address | Creswell, NC 27928-9624 |
Second Address | Edenton, NC 27932-8503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/05/2008 |