Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003264979 |
---|---|
Provider Name | Tatem Alexandra Edwards |
First Address | Westmont, IL 60559-5548 |
Second Address | Des Moines, IA 50315-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 03/01/2019 |