Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 005441-1 | NY |
NPI | 1174749360 |
---|---|
Provider Name | Mrs. Jill A. Dungey |
First Address | Marcellus, NY 13108-9747 |
Second Address | Syracuse, NY 13214-2136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |