Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1030013 | TX |
NPI | 1760772404 |
---|---|
Provider Name | Kathy Gipe Mitchell |
First Address | Dallas, TX 75243-6306 |
Second Address | Dallas, TX 75246-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 14/04/2011 |