Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA49342 | CA |
NPI | 1013400712 |
---|---|
Provider Name | Alison Wiley |
First Address | Long Beach, CA 90814-1923 |
Second Address | Los Alamitos, CA 90720-3180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2018 |
Last Update Date | 08/06/2018 |