Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053612705 |
---|---|
Provider Name | Eliza Lehrke |
First Address | Fairfield, CA 94533-5702 |
Second Address | Fairfield, CA 94533-5702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2010 |
Last Update Date | 19/02/2020 |