Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTA3775 | CA |
NPI | 1396959144 |
---|---|
Provider Name | Antoinette Grayson |
First Address | Alta Loma, CA 91701 |
Second Address | Laguna Hills, CA 92653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |