Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE008105 | PA |
NPI | 1013155902 |
---|---|
Provider Name | Mrs. Victoria Shuleski |
First Address | Media, PA 19063-5519 |
Second Address | Media, PA 19063-5519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 30/01/2009 |