Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 012274 | OH |
NPI | 1003069956 |
---|---|
Provider Name | Mrs. Jennifer Lynn Advent |
First Address | Gahanna, OH 43230-4573 |
Second Address | Gahanna, OH 43230-4573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 19/04/2010 |