Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | J1-0001322 | DE |
Y | 225100000X | Physical Therapist | PT016702 | PA |
NPI | 1003018938 |
---|---|
Provider Name | Ms. Kathleen Pankowski |
First Address | Wilmington, DE 19810-3714 |
Second Address | Glen Mills, PA 19342-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |