Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT30278 | CA |
NPI | 1306964796 |
---|---|
Provider Name | Daniel Corkish |
First Address | Millbrae, CA 94030-0816 |
Second Address | Burlingame, CA 94010-3117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 26/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT30278 | PT LICENSE (01) | CA |