Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 246 | AL |
NPI | 1376791558 |
---|---|
Provider Name | Mr. Kathleen Kenny Hamilton |
First Address | Mobile, AL 36609-3300 |
Second Address | Mobile, AL 36607-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2008 |
Last Update Date | 31/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246 | PHYSICAL THERAPIST (01) | AL |