Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0002673 | CO |
NPI | 1255737441 |
---|---|
Provider Name | Ms. Lezah Tabush |
First Address | Montrose, CO 81401-5605 |
Second Address | Montrose, CO 81401-5605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 14/11/2014 |