Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 36831 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT 36831 | CA |
NPI | 1053680330 |
---|---|
Provider Name | Anne Osborn |
First Address | Los Angeles, CA 90034-3216 |
Second Address | Los Angeles, CA 90034-3216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 15/12/2011 |