Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1364 | NC |
NPI | 1013289099 |
---|---|
Provider Name | Mrs. Alicia Durante Clifford |
First Address | Charlotte, NC 28270-1062 |
Second Address | Charlotte, NC 28269-7656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2012 |
Last Update Date | 06/02/2012 |