Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 62031062 | NY |
N | 225100000X | Physical Therapist | PP66003 | NY |
NPI | 1003066531 |
---|---|
Provider Name | Ryanne Tanae Glasper |
First Address | Brooklyn, NY 11216-1610 |
Second Address | New York, NY 10018-9048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2008 |
Last Update Date | 23/01/2009 |