Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160041753 | WA |
NPI | 1003369711 |
---|---|
Provider Name | Mrs. Gloria Marley |
First Address | Yakima, WA 98908-8606 |
Second Address | Yakima, WA 98902-3521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |