Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 033788-1 | NY |
Y | 225100000X | Physical Therapist | PT021676 | PA |
NPI | 1003192170 |
---|---|
Provider Name | Roma Rosas Dizon |
First Address | Columbia, NJ 07832-2301 |
Second Address | Columbia, NJ 07832-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 29/08/2012 |