Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 004112 | CT |
NPI | 1003100835 |
---|---|
Provider Name | Mrs. Paula White |
First Address | Cromwell, CT 06416-1019 |
Second Address | Cromwell, CT 06416-1019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 09/06/2011 |