Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0006631 | CO |
NPI | 1043733355 |
---|---|
Provider Name | Wendy Michelle Eickmann |
First Address | Loveland, CO 80537-7520 |
Second Address | Longmont, CO 80503-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 18/07/2017 |