Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A00645 | KY |
NPI | 1013112937 |
---|---|
Provider Name | Mrs. Deborah Richardson |
First Address | London, KY 40743-2328 |
Second Address | London, KY 40741-8601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A00645 | STATE LICENSE (01) | KY |