Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 24046 | MD |
N | 2251G0304X | Physical Therapist - Geriatrics | 2305204824 | VA |
NPI | 1184748048 |
---|---|
Provider Name | Samiat Bisola Tumasang |
First Address | Frederick, MD 21702-2514 |
Second Address | Frederick, MD 21702-2514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2007 |
Last Update Date | 04/04/2017 |