Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT42087 | CA |
NPI | 1003202862 |
---|---|
Provider Name | Amy Lynn Alaby |
First Address | Carlsbad, CA 92008-2310 |
Second Address | Vista, CA 92083-6031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 01/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | MEDICARE PTAN (01) | CA |