Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 2305208094 | VA |
NPI | 1447782826 |
---|---|
Provider Name | Lindsay Ebersole |
First Address | Mechanicsville, VA 23116-1844 |
Second Address | Mechanicsville, VA 23116-1844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 03/04/2017 |