Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 032907 | NY |
NPI | 1003189697 |
---|---|
Provider Name | Jillian Erickson |
First Address | Ithaca, NY 14850-1589 |
Second Address | Ithaca, NY 14850-1589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 19/02/2015 |