Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 7302 | OH |
NPI | 1013347111 |
---|---|
Provider Name | Mrs. Stacey Crosby |
First Address | Westerville, OH 43081-3055 |
Second Address | Columbus, OH 43222-1539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2013 |
Last Update Date | 26/11/2013 |