Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 24248 | MD |
NPI | 1083053102 |
---|---|
Provider Name | Prajakta Sule |
First Address | Harrison, NJ 07029-2502 |
Second Address | Millersville, MD 21108-1363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 21/06/2013 |