Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QAOO730900 | NJ |
NPI | 1346443785 |
---|---|
Provider Name | Miss Mildred Magsanoc |
First Address | Sicklerville, NJ 08081-1692 |
Second Address | Atco, NJ 08004-2457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |