Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3528 | AL |
NPI | 1003332024 |
---|---|
Provider Name | Wendy Maronge |
First Address | Summit, MS 39666-9132 |
Second Address | Pell City, AL 35125-5117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2017 |
Last Update Date | 22/08/2017 |