Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 292798 | CA |
NPI | 1336677889 |
---|---|
Provider Name | Brian R White |
First Address | Riverside, CA 92507-8511 |
Second Address | San Diego, CA 92111-3744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2017 |
Last Update Date | 29/05/2017 |