Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013510395 |
---|---|
Provider Name | Christopher Oconnor |
First Address | Modesto, CA 95356-9607 |
Second Address | Modesto, CA 95356-9607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 18/11/2020 |