Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 11180 | CA |
NPI | 1134380884 |
---|---|
Provider Name | Alice Lurline Long |
First Address | San Rafael, CA 94903-2911 |
Second Address | San Rafael, CA 94903-4879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 24/06/2008 |