Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 05008365A | IN |
NPI | 1326374455 |
---|---|
Provider Name | Ratana Ito |
First Address | Indianapolis, IN 46280-1555 |
Second Address | Indianapolis, IN 46280-1555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2009 |
Last Update Date | 23/10/2009 |