Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 05001834A | IN |
NPI | 1093026239 |
---|---|
Provider Name | Laura Marie Durig |
First Address | Indianapolis, IN 46231-3210 |
Second Address | Indianapolis, IN 46231-3210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 22/06/2010 |