Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-1193 | NM |
NPI | 1013375252 |
---|---|
Provider Name | Mrs. Cynthia Wiley |
First Address | Rio Rancho, NM 87144-5344 |
Second Address | Albuquerque, NM 87102-1708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2016 |
Last Update Date | 08/02/2016 |