Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1265933188 |
---|---|
Provider Name | Jill A Clagett |
First Address | Bethlehem, PA 18018-1105 |
Second Address | Bethlehem, PA 18018-1105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 03/02/2021 |