Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 771 | HI |
NPI | 1073195509 |
---|---|
Provider Name | Martha Lucila Vera Hovestol |
First Address | Bowling Green, KY 42103-8435 |
Second Address | Waipahu, HI 96797-4485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2021 |
Last Update Date | 23/04/2021 |