Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 040049 | NY |
NPI | 1003270521 |
---|---|
Provider Name | Priyanka Trivedi |
First Address | Milwaukee, WI 53221-2102 |
Second Address | Milwaukee, WI 53221-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 11/04/2016 |