Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003197203 |
---|---|
Provider Name | Fredric Art Quintos Sayao |
First Address | Garden Grove, CA 92844-1615 |
Second Address | Garden Grove, CA 92844-1615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 29/07/2013 |