Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1033306832 |
---|---|
Provider Name | Mrs. Joanna-Dawn Alberta Whitlock Streets |
First Address | New York, NY 10003 |
Second Address | New York, NY 10003-8263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 29/09/2010 |