Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1114203734 |
---|---|
Provider Name | Ms. Tamara Antonia Stojadinovic |
First Address | Progreso, MEXICO 97320 |
Second Address | Fort Worth, TX 76135-4906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2011 |
Last Update Date | 27/10/2011 |