Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5031 | NC |
NPI | 1104065028 |
---|---|
Provider Name | Vanesa Garces |
First Address | Charlotte, NC 28205-3604 |
Second Address | Charlotte, NC 28205-3604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 17/02/2009 |