Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | P19796 | NC |
NPI | 1114539889 |
---|---|
Provider Name | Madison Myers |
First Address | Fayetteville, NC 28303-4887 |
Second Address | Dunn, NC 28334-4853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2020 |
Last Update Date | 23/08/2020 |