Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1174099154 |
---|---|
Provider Name | Lynn Wong |
First Address | Salem, NH 03079-4804 |
Second Address | Salem, NH 03079-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |