Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1626 | VA |
NPI | 1053521484 |
---|---|
Provider Name | Prof. Charlesey Lishelle Jeffers |
First Address | Spotsylvania, VA 22553-4470 |
Second Address | Washington, DC 20422-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |