Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 13527 | CA |
NPI | 1063717072 |
---|---|
Provider Name | Caryn Ito |
First Address | Huntington Beach, CA 92648-2030 |
Second Address | Huntington Beach, CA 92648-2030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 21/01/2011 |