Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT017459 | PA |
NPI | 1003296997 |
---|---|
Provider Name | Sherley Vasquez |
First Address | Shenandoah, PA 17976-1232 |
Second Address | Shenandoah, PA 17976-1232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 04/06/2015 |