Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 037094 | NY |
N | 225100000X | Physical Therapist | PT-4056 | HI |
NPI | 1003206426 |
---|---|
Provider Name | Maria Pereira |
First Address | West Chester, PA 19382-7321 |
Second Address | West Chester, PA 19382-7321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2015 |
Last Update Date | 03/05/2016 |