Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 8727347 | NY |
NPI | 1346602398 |
---|---|
Provider Name | Tara Prishwalko |
First Address | Hamburg, NY 14075-1111 |
Second Address | Hamburg, NY 14075-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 28/03/2016 |