Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8821 | OH |
NPI | 1003137563 |
---|---|
Provider Name | Jill M. Faber |
First Address | Mentor On The Lake, OH 44060-3742 |
Second Address | Painesville, OH 44077-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0747777 | (05) | OH |