Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 28998-PT | CA |
NPI | 1679723407 |
---|---|
Provider Name | Audrey Lamar Owens |
First Address | San Francisco, CA 94131-2768 |
Second Address | San Mateo, CA 94401-3805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 29/09/2008 |