Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | ||
Y | 225200000X | Physical Therapy Assistant | 09808 | OR |
NPI | 1003441742 |
---|---|
Provider Name | Tetyana Matveyeva |
First Address | Helena, MT 59602-9742 |
Second Address | Glenview, IL 60026-8001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2020 |
Last Update Date | 21/07/2021 |