Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE1002855 | PA |
NPI | 1013303924 |
---|---|
Provider Name | Patricia Smith |
First Address | Boyertown, PA 19512-7926 |
Second Address | Topton, PA 19562-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 08/04/2015 |