Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-4809 | OH |
NPI | 1003022849 |
---|---|
Provider Name | Mrs. Nancy Alice Adams |
First Address | Avon, OH 44011-3717 |
Second Address | Avon, OH 44011-1390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 15/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT-4809 | PHYSICAL THERAPY LICENSE (01) | OH |