Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A4061 | NC |
NPI | 1013418177 |
---|---|
Provider Name | Mrs. Ilona Karin Ekstrand |
First Address | Raeford, NC 28376-6270 |
Second Address | Fayetteville, NC 28301-2824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2018 |
Last Update Date | 23/02/2018 |