Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306001390 | VA |
NPI | 1013151794 |
---|---|
Provider Name | Patti Jo D'innocenzo Keeler |
First Address | Richmond, VA 23233-7564 |
Second Address | Richmond, VA 23233-7017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 27/04/2009 |