Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 8751 | MA |
NPI | 1114451473 |
---|---|
Provider Name | Lynne Mia Davis |
First Address | West Springfield, MA 01089-1099 |
Second Address | West Springfield, MA 01089-1099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 13/04/2017 |