Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 294684 | CA |
NPI | 1760978233 |
---|---|
Provider Name | Molly Nora Dymond |
First Address | Blacksburg, VA 24060-8666 |
Second Address | Pinole, CA 94564-2524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2018 |
Last Update Date | 07/07/2018 |