Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 034017 | NY |
Y | 225100000X | Physical Therapist | P15498 | NC |
NPI | 1003104654 |
---|---|
Provider Name | Kiersten Flynn |
First Address | Campbell Hall, NY 10916-2743 |
Second Address | Clayton, NC 27520-4822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 21/04/2015 |