Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | ATR-009143 | AZ |
NPI | 1164054797 |
---|---|
Provider Name | Mia Elizabeth Korum |
First Address | Scottsdale, AZ 85255-4479 |
Second Address | Scottsdale, AZ 85255-4479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2020 |
Last Update Date | 11/02/2020 |