Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 030052 | NY |
NPI | 1003118035 |
---|---|
Provider Name | Ms. Renee Kimberly Dance |
First Address | Brooklyn, NY 11213-3301 |
Second Address | Brooklyn, NY 11213-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2010 |
Last Update Date | 24/11/2010 |