Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 10704 | OH |
N | 2251G0304X | Physical Therapist - Geriatrics | 1866 | NV |
NPI | 1174874085 |
---|---|
Provider Name | Krista Jaclyn Dugan |
First Address | Grandview Heights, OH 43212-3617 |
Second Address | Columbus, OH 43220-2262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 02/10/2012 |