Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1171680 | TX |
NPI | 1104055375 |
---|---|
Provider Name | Ms. Susan Ashley Vonvillas |
First Address | Tomball, TX 77375-1125 |
Second Address | Tomball, TX 77375-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 22/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
283158801 | (05) | TX |