Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305000759 | VA |
NPI | 1063494300 |
---|---|
Provider Name | Ms. Kristin V. Ives |
First Address | Front Royal, VA 22630-2360 |
Second Address | Front Royal, VA 22630-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 08/07/2007 |