Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA4536 | MS |
NPI | 1013202779 |
---|---|
Provider Name | Lilly Hardin |
First Address | Fulton, MS 38843-8528 |
Second Address | Fulton, MS 38843-8528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 10/06/2011 |