Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 005493-1 | NY |
NPI | 1013155860 |
---|---|
Provider Name | Sue Ann Tupper |
First Address | Liverpool, NY 13088-5622 |
Second Address | Bath, NY 14810-9504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 02/02/2009 |