Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 026155-1 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 026155-1 | NY |
N | 2251S0007X | Physical Therapist - Sports | 026155-1 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | 026155-1 | NY |
NPI | 1497792709 |
---|---|
Provider Name | Miss Mary Roanne Flores |
First Address | Hastings On Hudson, NY 10706-2809 |
Second Address | Scarsdale, NY 10583-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 03/10/2013 |