Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QAO742200 | NJ |
NPI | 1003013541 |
---|---|
Provider Name | Patricia Mary Vizzard |
First Address | Collingswood, NJ 08108-1204 |
Second Address | Haverford, PA 19041-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/07/2007 |