Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0343 | SD |
NPI | 1275853962 |
---|---|
Provider Name | Lori Sapp |
First Address | Bruce, SD 57220-5718 |
Second Address | White, SD 57276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2010 |
Last Update Date | 04/06/2010 |