Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 40QA00884100 | NJ |
NPI | 1255090981 |
---|---|
Provider Name | Kathleen Elaine Grafke-Dallos |
First Address | Eastampton, NJ 08060-9656 |
Second Address | Mount Laurel, NJ 08054-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |