Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 294578 | CA |
NPI | 1265936710 |
---|---|
Provider Name | Dr. Michael Joseph |
First Address | Los Alamitos, CA 90720-2216 |
Second Address | Pasadena, CA 91105-3223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 20/03/2018 |