Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT015306 | PA |
NPI | 1184749608 |
---|---|
Provider Name | Miss Jill Elizabeth Fennelly |
First Address | Philadelphia, PA 19128-2620 |
Second Address | Philadelphia, PA 19115-3730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |