Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 08643-1 | NY |
NPI | 1124169461 |
---|---|
Provider Name | Ms. Patricia Ann Zumpol |
First Address | Wading River, NY 11792-1849 |
Second Address | Port Jefferson, NY 11777-1928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |