Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A1578 | MN |
NPI | 1013251446 |
---|---|
Provider Name | Jowita Kinney |
First Address | Saint Paul, MN 55101-2502 |
Second Address | Minneapolis, MN 55454-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |