Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | HI |
NPI | 1013113786 |
---|---|
Provider Name | Ms. Elke Monika Etcheberry |
First Address | Bremerton, WA 98311-4067 |
Second Address | Bremerton, WA 98312-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1780756932 | (02) | WA |
4111589 | (05) | WA |