Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306601527 | VA |
NPI | 1003005901 |
---|---|
Provider Name | Mrs. Nina M Anderson II |
First Address | Virginia Beach, VA 23454-6648 |
Second Address | Virginia Beach, VA 23454-6648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/10/2007 |