Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 24402 | MD |
Y | 2251P0200X | Physical Therapist - Pediatrics | 292107 | CA |
NPI | 1003157892 |
---|---|
Provider Name | Eleanor Bachman |
First Address | Santa Monica, CA 90404-1310 |
Second Address | Santa Monica, CA 90404-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 01/04/2020 |