Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 27397 | CA |
N | 2251S0007X | Physical Therapist - Sports | 27397 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 27397 | CA |
NPI | 1427274869 |
---|---|
Provider Name | Amy Brooke Fee |
First Address | Santa Monica, CA 90404-2756 |
Second Address | Santa Monica, CA 90404-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 15/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7030 | PT LICENSE NUMBER (01) | CO |
7521525 | AETNA (01) | CA |
W22042 | MEDICARE PTAN (01) | CA |
ZZZ08333Z | BLUE SHIELD (01) | CA |