Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 62 036358 | NY |
NPI | 1245679877 |
---|---|
Provider Name | Namita Rao |
First Address | Jamaica, NY 11427-1012 |
Second Address | Jamaica, NY 11427-1012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 29/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45-3746636 | (02) | NY |
45-3746636 | (05) | NY |