Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 41850 | CA |
NPI | 1083019236 |
---|---|
Provider Name | Drew Thompson |
First Address | Vacaville, CA 95688-2803 |
Second Address | Vacaville, CA 95688-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2014 |
Last Update Date | 07/11/2014 |