Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1065241 | TX |
NPI | 1255811303 |
---|---|
Provider Name | Maria Ibana Santos |
First Address | Richardson, TX 75082-2464 |
Second Address | Richardson, TX 75082-2464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |