Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 225200000X | Physical Therapy Assistant | 1323034 | TX |
NPI | 1013537026 |
---|---|
Provider Name | Samantha Ewing |
First Address | Richardson, TX 75080-5623 |
Second Address | Richardson, TX 75080-5623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 14/09/2021 |