Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 001085 | CT |
NPI | 1184867368 |
---|---|
Provider Name | Joan Taber |
First Address | Branford, CT 06405-4771 |
Second Address | Branford, CT 06405-4771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 17/04/2009 |