Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1088 | ND |
NPI | 1003234808 |
---|---|
Provider Name | Tracy Anderson |
First Address | Jamestown, ND 58401-6201 |
Second Address | Jamestown, ND 58401-6201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 31/03/2014 |