Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306001227 | VA |
NPI | 1003488511 |
---|---|
Provider Name | Roxanne Brinkman |
First Address | Sutherland, VA 23885-8947 |
Second Address | Petersburg, VA 23805-9214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2021 |
Last Update Date | 14/07/2021 |