Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1821009275 |
---|---|
Provider Name | Mrs. Susan Diane Clancy |
First Address | North Olmsted, OH 44070-3817 |
Second Address | Brecksville, OH 44141-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |