Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 36669 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 36669 | CA |
NPI | 1528361698 |
---|---|
Provider Name | Dr. Corydon Marrs |
First Address | Pasadena, CA 91106-5348 |
Second Address | Pasadena, CA 91106-5348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2010 |
Last Update Date | 28/12/2011 |