Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 003086 | NY |
NPI | 1003074642 |
---|---|
Provider Name | Patricia Demartino |
First Address | Farmingdale, NY 11735-2026 |
Second Address | Woburn, MA 01801-6519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 30/05/2008 |