Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 007013 | CT |
NPI | 1336534817 |
---|---|
Provider Name | Ms. Heidi Putman |
First Address | Hicksville, NY 11801-4437 |
Second Address | Hicksville, NY 11801-4437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 01/04/2015 |