Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA002963 | GA |
NPI | 1003203720 |
---|---|
Provider Name | Priscilla Lavallee Kane |
First Address | Roswell, GA 30075-3969 |
Second Address | Roswell, GA 30075-3969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |