Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003322561 |
---|---|
Provider Name | Ma Anna Karenina Mella |
First Address | Rockville, MD 20850-6343 |
Second Address | Indianapolis, IN 46278-1737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2017 |
Last Update Date | 22/01/2018 |