Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE002600L | PA |
NPI | 1003959339 |
---|---|
Provider Name | Mrs. Tonya Kaye Garges |
First Address | Towanda, PA 18848-9710 |
Second Address | Towanda, PA 18848-9710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TE002600L | LICENSE NUMBER (01) | PA |