Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2200 | AK |
NPI | 1003239880 |
---|---|
Provider Name | Jessie Lief |
First Address | Anchorage, AK 99507 |
Second Address | Anchorage, AK 99507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2014 |
Last Update Date | 29/01/2014 |