Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT008016L | PA |
NPI | 1194933150 |
---|---|
Provider Name | Mrs. Josephine Clancy |
First Address | Spring City, PA 19475-2707 |
Second Address | Darby, PA 19023-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |