Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 070014380 | IL |
Y | 2251P0200X | Physical Therapist - Pediatrics | P17421 | NC |
NPI | 1093841389 |
---|---|
Provider Name | Kathryn Fronczak |
First Address | Charlotte, NC 28277-1720 |
Second Address | Charlotte, NC 28277-5723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093841389 | (05) | IL |