Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | A241 | MN |
NPI | 1225498769 |
---|---|
Provider Name | Mariam K Slayhi |
First Address | Bloomington, MN 55420-3714 |
Second Address | Bloomington, MN 55420-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 25/02/2016 |