Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | NY |
NPI | 1891725826 |
---|---|
Provider Name | Mrs. Tisa Ann Givens |
First Address | Hackensack, NJ 07601-3007 |
Second Address | Hackensack, NJ 07601-3007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |