Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT00006116 | WA |
NPI | 1639262629 |
---|---|
Provider Name | Mrs. Robyn Claire Moug |
First Address | Deer Park, WA 99006-9368 |
Second Address | Deer Park, WA 99006-9368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |