Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 035868-1 | NY |
NPI | 1003152398 |
---|---|
Provider Name | Katherine Spencer |
First Address | New York, NY 10025-2901 |
Second Address | New York, NY 10025-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2012 |
Last Update Date | 28/03/2016 |