Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06003089A | IN |
NPI | 1013269414 |
---|---|
Provider Name | Ms. Kimberly Marcia Jines |
First Address | Princeton, IN 47670-9513 |
Second Address | Princeton, IN 47670-9513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2012 |
Last Update Date | 09/10/2012 |