Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1043851231 |
---|---|
Provider Name | Brooke Fantin |
First Address | Oakland, CA 94607-6404 |
Second Address | Oakland, CA 94607-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 30/09/2019 |