Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1396141669 |
---|---|
Provider Name | Michelle Nwankwor |
First Address | Grand Prairie, TX 75052-2272 |
Second Address | Grand Prairie, TX 75052-2272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 13/11/2014 |