Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0324 | WY |
NPI | 1013208974 |
---|---|
Provider Name | Lori Caldwell |
First Address | Lander, WY 82520-3033 |
Second Address | Lander, WY 82520-3033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 14/03/2012 |