Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 019691-1 | NY |
NPI | 1063659266 |
---|---|
Provider Name | Mrs. Esther Tusk |
First Address | Far Rockaway, NY 11691-1741 |
Second Address | Far Rockaway, NY 11691-1741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2009 |
Last Update Date | 10/01/2009 |