Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160980588 | WA |
NPI | 1013278712 |
---|---|
Provider Name | Ms. Serena Harker |
First Address | Vancouver, WA 98664-4539 |
Second Address | Vancouver, WA 98664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 14/08/2019 |