Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1259907 | TX |
NPI | 1457878480 |
---|---|
Provider Name | Mrs. Courtney Irvine |
First Address | Fort Worth, TX 76104-4110 |
Second Address | Fort Worth, TX 76104-4110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2017 |
Last Update Date | 30/08/2017 |