Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06005807A | IN |
NPI | 1003384397 |
---|---|
Provider Name | Tomico Camille Spears |
First Address | Crown Point, IN 46307-9691 |
Second Address | Louisville, KY 40299-6395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 05/11/2018 |