Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1162067 | TX |
NPI | 1043412810 |
---|---|
Provider Name | Mrs. Erika Brassow |
First Address | Wimberley, TX 78676-3034 |
Second Address | Wimberley, TX 78676-5311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 01/09/2009 |