Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 004032 | GA |
NPI | 1093902843 |
---|---|
Provider Name | Ms. Valerie Harris Squillario |
First Address | Atlanta, GA 30342-3701 |
Second Address | Atlanta, GA 30342-3701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 26/09/2007 |