Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305006000 | VA |
NPI | 1073739785 |
---|---|
Provider Name | Susan Perkins |
First Address | Vienna, VA 22181-6168 |
Second Address | Springfield, VA 22152-1663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |