Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 05002122A |
NPI | 1063530426 |
---|---|
Provider Name | Mrs. Mary F Spickard |
First Address | Hamlet, IN 46532 |
Second Address | Hamlet, IN 46532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122235 | CSHCS (01) | IN |