Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 14984 | CA |
NPI | 1225426406 |
---|---|
Provider Name | Gordon Kirkup |
First Address | Los Angeles, CA 90029-3441 |
Second Address | Los Angeles, CA 90029-3441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |