Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 03032 | IA |
NPI | 1023546728 |
---|---|
Provider Name | Theresa Marie Alt |
First Address | Marion, IA 52302-1308 |
Second Address | Marion, IA 52302-5817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2017 |
Last Update Date | 25/05/2017 |