Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1086 | TN |
NPI | 1558571992 |
---|---|
Provider Name | Mrs. Doretha Staples |
First Address | Bartlett, TN 38133-0914 |
Second Address | Bartlett, TN 38133-0914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |