Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06003177A | IN |
NPI | 1003143769 |
---|---|
Provider Name | Mrs. Joann Catherine Roessner |
First Address | Portland, IN 47371 |
Second Address | Albany, IN 47320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2009 |
Last Update Date | 17/11/2009 |