Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT005340L | PA |
NPI | 1730731571 |
---|---|
Provider Name | Joy Elaine Proctor |
First Address | Williamsport, PA 17701-3100 |
Second Address | Williamsport, PA 17701-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 11/07/2019 |