Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2154140 | TX |
NPI | 1043838204 |
---|---|
Provider Name | Tiffany Ainsworth |
First Address | Houston, TX 77081-2259 |
Second Address | Houston, TX 77081-2259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2020 |
Last Update Date | 13/07/2020 |