Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1127116 | TX |
NPI | 1194313684 |
---|---|
Provider Name | Kalynne Wolford |
First Address | Prosper, TX 75078-1405 |
Second Address | Prosper, TX 75078-1405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2021 |
Last Update Date | 09/01/2021 |