Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5316 | OH |
NPI | 1013471077 |
---|---|
Provider Name | Judy Grubb |
First Address | North Lawrence, OH 44666-9610 |
Second Address | Brewster, OH 44613-1199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 24/01/2019 |