Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 11455 | NC |
NPI | 1154947661 |
---|---|
Provider Name | Ma Lourdes Maderazo Tadlip |
First Address | Raleigh, NC 27605-1237 |
Second Address | Raleigh, NC 27605-1237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2020 |
Last Update Date | 20/06/2020 |