Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | J2-0000807 | DE |
NPI | 1003102872 |
---|---|
Provider Name | Susan J Gale |
First Address | Wilmington, DE 19808-2826 |
Second Address | Wilmington, DE 19808-2826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 21/06/2011 |