Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 037433 | NY |
NPI | 1184228470 |
---|---|
Provider Name | Melissa Maura |
First Address | New City, NY 10956-5933 |
Second Address | Valhalla, NY 10595-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2020 |
Last Update Date | 26/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037433 | NY LICENSE OF PROFESSIONALS (01) | NY |