Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT17060 | CA |
N | 2251N0400X | Physical Therapist - Neurology | PT17060 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT 17060 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT17060 | CA |
NPI | 1003902735 |
---|---|
Provider Name | Dr. Noelle Gilson Budrovich |
First Address | Torrance, CA 90505-2803 |
Second Address | Torrance, CA 90505-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 19/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W16657 | (02) | CA |
WPT17060A | (02) | CA |