Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 42779 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1063894434 |
---|---|
Provider Name | Aaron Bright |
First Address | El Segundo, CA 90245-2850 |
Second Address | El Segundo, CA 90245-2850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 06/03/2019 |