Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 19827 | MA |
NPI | 1003189358 |
---|---|
Provider Name | Ms. Joanna Leigh Daluze |
First Address | Harwich, MA 02645-1937 |
Second Address | Hyannis, MA 02601-3825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2012 |
Last Update Date | 17/02/2012 |