Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 004253 | IA |
NPI | 1013252113 |
---|---|
Provider Name | Lindsey Ann Kofoot |
First Address | Grinnell, IA 50112-8160 |
Second Address | Grinnell, IA 50112-8160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2012 |
Last Update Date | 30/11/2012 |