Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1023629169 |
---|---|
Provider Name | Carolyn Coombs |
First Address | San Rafael, CA 94901-2648 |
Second Address | San Rafael, CA 94901-2648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2020 |
Last Update Date | 12/08/2020 |