Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 007979 | NY |
Y | 225200000X | Physical Therapy Assistant | 06004518A | IN |
NPI | 1003168709 |
---|---|
Provider Name | Maria Cristina Co Gerona |
First Address | Crown Point, IN 46307-8438 |
Second Address | Louisville, KY 40222-5185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2012 |
Last Update Date | 04/12/2012 |