Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 000621 | WV |
NPI | 1003150624 |
---|---|
Provider Name | Mrs. Kristina Alice Breesawitz |
First Address | Parkersburg, WV 26101-6940 |
Second Address | Parkersburg, WV 26101-9655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 27/02/2013 |