Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1262376 | TX |
NPI | 1336768472 |
---|---|
Provider Name | Kelly Dawson |
First Address | Fort Worth, TX 76132-6108 |
Second Address | Fort Worth, TX 76132-6108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NA (01) |