Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 04452 | LA |
NPI | 1003173295 |
---|---|
Provider Name | Mrs. Joy Birdwell Petty |
First Address | Zachary, LA 70791-2347 |
Second Address | Zachary, LA 70791-2347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 03/02/2014 |