Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 009021-1 | NY |
Y | 2251P0200X | Physical Therapist - Pediatrics | 009021-1 | NY |
NPI | 1003044405 |
---|---|
Provider Name | Mrs. Beth E Parks |
First Address | Johnson City, NY 13790-4206 |
Second Address | Johnson City, NY 13790-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 24/06/2009 |