Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | A4983 | MD |
Y | 225200000X | Physical Therapy Assistant | PTA000178 | DC |
NPI | 1003309303 |
---|---|
Provider Name | Jessica Taylor |
First Address | Wilmington, DE 19808-5505 |
Second Address | Washington, DC 20010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 09/08/2018 |