Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT021258 | PA |
NPI | 1043581507 |
---|---|
Provider Name | Mrs. Aimee Slattery |
First Address | Cranberry Twp, PA 16066-6436 |
Second Address | Cranberry Twp, PA 16066-6436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2012 |
Last Update Date | 14/01/2012 |