Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT 1478 | AR |
NPI | 1063534675 |
---|---|
Provider Name | Princess Rose Gates-Windham |
First Address | Little Rock, AR 72223-8513 |
Second Address | Little Rock, AR 72227-6212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131668721 | (05) | AR |