Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 010024-1 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 010024-1 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 010024-1 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 010024-1 | NY |
NPI | 1790930691 |
---|---|
Provider Name | Linda Patrice Kaja-Mulvena |
First Address | Glendale, NY 11385-7705 |
Second Address | Glendale, NY 11385-7705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |