Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 11088 | CA |
NPI | 1114290160 |
---|---|
Provider Name | Dr. Jessica Rose |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |