Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT013981L | PA |
NPI | 1104871987 |
---|---|
Provider Name | Kiersten Shevchik |
First Address | Delmont, PA 15626-7209 |
Second Address | Delmont, PA 15626-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 02/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01854565 | (05) | PA |