Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01758200 | NJ |
N | 2251G0304X | Physical Therapist - Geriatrics | 40QA01758200 | NJ |
NPI | 1346752748 |
---|---|
Provider Name | Kabulo Blanche Mwilambwe |
First Address | Jersey City, NJ 07307-1229 |
Second Address | West Orange, NJ 07052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2017 |
Last Update Date | 26/10/2017 |