Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6910 | CO |
NPI | 1043269988 |
---|---|
Provider Name | Ms. Leanora Theresa Premeau |
First Address | Salida, CO 81201-2822 |
Second Address | Salida, CO 81201-2822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |