Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 07864 | LA |
NPI | 1215309703 |
---|---|
Provider Name | Mari Kantrow |
First Address | Baton Rouge, LA 70808-4311 |
Second Address | Baton Rouge, LA 70808-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2015 |
Last Update Date | 23/10/2015 |