Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003065822 |
---|---|
Provider Name | Marilyn Nicolette Ciavarra |
First Address | Latrobe, PA 15650-2500 |
Second Address | Kennett Square, PA 19348-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 17/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT007688L | STATE LICENSE (01) | PA |