Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 035834 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 035834-1 | NY |
NPI | 1114263555 |
---|---|
Provider Name | Lauren Kathryn Zietsman |
First Address | Vestal, NY 13850-3824 |
Second Address | Owego, NY 13827-3815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 06/08/2018 |