Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06259 | OH |
NPI | 1013324219 |
---|---|
Provider Name | Melissa Waker |
First Address | Germantown, OH 45327-1712 |
Second Address | Germantown, OH 45327-1712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2014 |
Last Update Date | 20/07/2014 |