Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 60211658 | WA |
N | 2251N0400X | Physical Therapist - Neurology | PT 60211658 | WA |
NPI | 1356632871 |
---|---|
Provider Name | Miss Elizabeth Marie Long |
First Address | Belton, MO 64012-4225 |
Second Address | Seattle, WA 98101-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2011 |
Last Update Date | 02/05/2011 |