Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 018789 | NY |
NPI | 1043596737 |
---|---|
Provider Name | Joan M Mingo |
First Address | Monticello, NY 12701 |
Second Address | Monticello, NY 12701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 26/10/2011 |