Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1018067 | TX |
NPI | 1134137250 |
---|---|
Provider Name | Mrs. Gabriele D. Rose |
First Address | Austin, TX 78731-5427 |
Second Address | Austin, TX 78731-5427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T1235 | BCBS PROVIDER # (01) | TX |