Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 023839 | NY |
Y | 225100000X | Physical Therapist | 02389 | NY |
NPI | 1992996672 |
---|---|
Provider Name | Ms. Viktoria Sidler |
First Address | Brooklyn, NY 11224 |
Second Address | Brooklyn, NY 11219-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 03/03/2009 |