Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE006568 | PA |
NPI | 1003987504 |
---|---|
Provider Name | Mrs. Krystal D Disney |
First Address | Roaring Spring, PA 16673-9801 |
Second Address | Duncansville, PA 16635-8341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |