Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5744-1 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 5744-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 5744-1 | NY |
NPI | 1720061773 |
---|---|
Provider Name | Venise Mule-Glass |
First Address | Commack, NY 11725-3401 |
Second Address | Commack, NY 11725-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 09/06/2008 |