Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | AT5026 | TX |
NPI | 1669889085 |
---|---|
Provider Name | Mrs. Lauren Dillon |
First Address | Corpus Christi, TX 78410-5745 |
Second Address | Corpus Christi, TX 78410-5745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2014 |
Last Update Date | 17/07/2014 |