Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT29149 | CA |
NPI | 1215234133 |
---|---|
Provider Name | Corriene Atup |
First Address | Petaluma, CA 94954-4348 |
Second Address | Petaluma, CA 94954-4348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2011 |
Last Update Date | 14/02/2011 |