NPI | 1003063645 |
---|---|
Former Name | SUSAN KAY DOLEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MD 16312) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: CA 12152) |
2251P0200X Physical Therapist, Pediatrics (Licence: MI 5501001231) | |
Enumeration Date | 2008-08-26 |
Last Update Date | 2008-08-26 |