Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A4524 | MD |
NPI | 1013581891 |
---|---|
Provider Name | Tracey Webster |
First Address | California, MD 20619-4021 |
Second Address | California, MD 20619-4021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2021 |
Last Update Date | 17/05/2021 |