Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 297099 | CA |
NPI | 1023664869 |
---|---|
Provider Name | Chris Kane |
First Address | Larkspur, CA 94939-1141 |
Second Address | Larkspur, CA 94939-1141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2019 |
Last Update Date | 16/08/2019 |