Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT00006132 | WA |
NPI | 1366641276 |
---|---|
Provider Name | Mrs. Elisabet Maria Taylor |
First Address | Bainbridge Island, WA 98110-4333 |
Second Address | Bremerton, WA 98312-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 28/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1780756932 | (02) | WA |
4111589 | (05) | WA |