NPI | 1275655532 |
---|---|
Former Name | COLLEEN WESCOTT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01160500) |
Additional Taxonomies | 171W00000X Contractor (Licence: NJ 40QA01160500) |
225100000X Physical Therapist (Licence: MD 22009) | |
Enumeration Date | 2007-04-05 |
Last Update Date | 2012-08-07 |