Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-1149 | NV |
NPI | 1003469149 |
---|---|
Provider Name | Brian Wohlgemuth |
First Address | Los Angeles, CA 90039-4111 |
Second Address | Los Angeles, CA 90039-4111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2019 |
Last Update Date | 18/07/2019 |