Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 09041 | OH |
NPI | 1003397522 |
---|---|
Provider Name | Laura Nicole Maniaci |
First Address | Hilliard, OH 43026-1075 |
Second Address | Columbus, OH 43215-4767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |