Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1247183 | TX |
NPI | 1063884773 |
---|---|
Provider Name | Larrievel Fey Rodriguez Bourgoyne |
First Address | Meadows Place, TX 77477-2409 |
Second Address | Meadows Place, TX 77477-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2015 |
Last Update Date | 18/02/2016 |