Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1784 | ND |
NPI | 1487057907 |
---|---|
Provider Name | Sara Corbett |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 29/09/2014 |