Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | J1-0001959 | DE |
N | 2251S0007X | Physical Therapist - Sports | J1-0001959 | DE |
N | 2251X0800X | Physical Therapist - Orthopedic | J1-0001959 | DE |
NPI | 1265478283 |
---|---|
Provider Name | Suzanna Aguilar |
First Address | Dover, DE 19904-4802 |
Second Address | Dover, DE 19904-3478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7104738 | AETNA (01) | DE |
Q68857 | (02) | DE |