Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA4181 | AL |
NPI | 1013547462 |
---|---|
Provider Name | Sherry Kate Springfield |
First Address | Dothan, AL 36303-2015 |
Second Address | Dothan, AL 36303-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 23/01/2020 |