Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT42399 | CA |
NPI | 1427456805 |
---|---|
Provider Name | Dr. Caleb Burgess |
First Address | Orange, CA 92868-1505 |
Second Address | Orange, CA 92868-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 11/10/2021 |