Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 8377 | OR |
NPI | 1013280692 |
---|---|
Provider Name | Ms. Vivian Sara Weston |
First Address | Ashland, OR 97520-7317 |
Second Address | Ashland, OR 97520-1971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |