NPI | 1144686890 |
---|---|
Former Name | JODY JEAN RADLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 00796) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 900) |
225200000X Physical Therapy Assistant (Licence: KS 14-02204) | |
Enumeration Date | 2016-01-11 |
Last Update Date | 2016-01-11 |