Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 005996 | KY |
Y | 2251P0200X | Physical Therapist - Pediatrics | 05010733A | IN |
NPI | 1073886487 |
---|---|
Provider Name | Lisa Cecil |
First Address | Salem, OR 97301-4741 |
Second Address | Salem, OR 97301-4741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 12/03/2018 |