Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070001936 | IL |
Y | 225100000X | Physical Therapist | 2305206566 | VA |
N | 2251G0304X | Physical Therapist - Geriatrics | 070001936 | IL |
N | 2251G0304X | Physical Therapist - Geriatrics | 2305206566 | VA |
N | 2251N0400X | Physical Therapist - Neurology | 070001936 | IL |
N | 2251N0400X | Physical Therapist - Neurology | 2305206566 | VA |
NPI | 1437466224 |
---|---|
Provider Name | Mary Jo Given |
First Address | Wirtz, VA 24184-3689 |
Second Address | Wirtz, VA 24184-3689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2010 |
Last Update Date | 01/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
908160 | (02) | IL |