Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1275187643 |
---|---|
Provider Name | Brianna Bacich |
First Address | Laguna Hills, CA 92653-3634 |
Second Address | Laguna Hills, CA 92653-3634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2019 |
Last Update Date | 24/07/2019 |