Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 7169A | AZ |
NPI | 1013084813 |
---|---|
Provider Name | Sherry L. Nance |
First Address | Phoenix, AZ 85032-4805 |
Second Address | Phoenix, AZ 85032-4805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |