Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0000005852 | TN |
NPI | 1053930727 |
---|---|
Provider Name | Mrs. Jodi Litolff Yzaguirre |
First Address | Bartlett, TN 38002-8453 |
Second Address | Memphis, TN 38105-4934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2020 |
Last Update Date | 13/04/2020 |