Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 05009050A | IN |
NPI | 1013204809 |
---|---|
Provider Name | Mrs. Elizabeth Lestee Garrett |
First Address | Fishers, IN 46037-8202 |
Second Address | Indianapolis, IN 46256-3925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 30/06/2011 |