Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT-34481 | CA |
Y | 2251G0304X | Physical Therapist - Geriatrics | PT-3282 | HI |
NPI | 1124337415 |
---|---|
Provider Name | Nancy J. Shriver |
First Address | Hilo, HI 96720-1223 |
Second Address | Hilo, HI 96720-1202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2010 |
Last Update Date | 04/10/2010 |