Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 8297 | CO |
NPI | 1003074576 |
---|---|
Provider Name | Susan Caroline Flynn |
First Address | Fort Collins, CO 80521-2915 |
Second Address | Fort Collins, CO 80521-2915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 30/05/2008 |