Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 023863 | NY |
NPI | 1124272778 |
---|---|
Provider Name | Liezl Grace A Lonzame |
First Address | Bronx, NY 10465-3130 |
Second Address | Bronx, NY 10465-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 10/11/2008 |