Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE1000806 | PA |
NPI | 1003189259 |
---|---|
Provider Name | Nancy Lucille Kardos |
First Address | Erie, PA 16550-0002 |
Second Address | Erie, PA 16550-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2012 |
Last Update Date | 25/03/2021 |