Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0419 | NM |
NPI | 1003036948 |
---|---|
Provider Name | Mrs. Cheryl Lynn Brace |
First Address | Cortez, CO 81321-0482 |
Second Address | Cortez, CO 81321-2218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |