Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 1100105 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1100105 | TX |
NPI | 1013284819 |
---|---|
Provider Name | Mrs. Janice Abbott |
First Address | Dallas, TX 75231-4388 |
Second Address | Dallas, TX 75231-4388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2011 |
Last Update Date | 15/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
895T12 | BCBS (01) | TX |
896T14 | BCBS (01) | TX |