Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2136840 | TX |
NPI | 1013474204 |
---|---|
Provider Name | Kaitlin Torres |
First Address | Plano, TX 75093-7752 |
Second Address | Southlake, TX 76092-6526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2019 |
Last Update Date | 25/02/2019 |