Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 030560 | NY |
NPI | 1013236298 |
---|---|
Provider Name | Ms. Seberena K Page |
First Address | Brooklyn, NY 11234-3820 |
Second Address | Brooklyn, NY 11214-4684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2010 |
Last Update Date | 26/05/2010 |