Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1124105 | TX |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1396212312 |
---|---|
Provider Name | Karen Ann Travers |
First Address | Dallas, TX 75238-2209 |
Second Address | Dallas, TX 75246-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2018 |
Last Update Date | 20/04/2021 |