Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1303846 | TX |
NPI | 1194380022 |
---|---|
Provider Name | Ms. Thamizhselvi Chandrin |
First Address | Fort Worth, TX 76155-2956 |
Second Address | Arlington, TX 76012-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | (05) | TX |