Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5436 | MN |
NPI | 1114163052 |
---|---|
Provider Name | Ms. Jane Newman |
First Address | Minneapolis, MN 55409 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2008 |
Last Update Date | 24/12/2008 |