Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 991 | MS |
NPI | 1316028301 |
---|---|
Provider Name | Ms. Dianne Elizabeth Laseter |
First Address | Gulfport, MS 39503-4990 |
Second Address | Biloxi, MS 39531-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |