Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2123370 | TX |
NPI | 1013498021 |
---|---|
Provider Name | Whitley Saffron |
First Address | Austin, TX 78704-6749 |
Second Address | Austin, TX 78741-6633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |