Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0012958 | CO |
NPI | 1013465277 |
---|---|
Provider Name | Susan Hinton |
First Address | Lafayette, CO 80026-3463 |
Second Address | Lafayette, CO 80026-3463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2016 |
Last Update Date | 16/09/2016 |