Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2803 | NV |
NPI | 1003218561 |
---|---|
Provider Name | Jillian Johnson |
First Address | Reno, NV 89509-6120 |
Second Address | Reno, NV 89509-6120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2014 |
Last Update Date | 16/09/2014 |