Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 10411 | MA |
N | 2251P0200X | Physical Therapist - Pediatrics | 1834 | NH |
NPI | 1043355746 |
---|---|
Provider Name | Ms. Donna Bogdan Cordova |
First Address | Atkinson, NH 03811-2157 |
Second Address | Andover, MA 01810-5305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y68586 | BLUE CROSS - BLUE SHIELD (01) | MA |