Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 955 | OH |
NPI | 1265653075 |
---|---|
Provider Name | Mrs. Sara Jane Smith |
First Address | Columbus, OH 43214 |
Second Address | Columbus, OH 43214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |