Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 014249 | NY |
NPI | 1063848018 |
---|---|
Provider Name | Margaret De Ruijter |
First Address | Syracuse, NY 13219-2214 |
Second Address | Syracuse, NY 13219-2214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |