Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 010677-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 010677-1 | NY |
NPI | 1104150200 |
---|---|
Provider Name | Maria G. Tom |
First Address | Long Island City, NY 11101-5613 |
Second Address | Long Island City, NY 11101-5613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 23/09/2009 |