Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | NY |
NPI | 1053889279 |
---|---|
Provider Name | Riley Marion |
First Address | Buffalo, NY 14222-2232 |
Second Address | Orchard Park, NY 14127-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |