Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT17235 | CA |
N | 2251H1200X | Hand | PT17235 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 17235 | CA |
NPI | 1003890229 |
---|---|
Provider Name | Christine Marie Eddow |
First Address | Corona, CA 92882-2533 |
Second Address | Corona, CA 92882-2531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 07/11/2019 |