Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1053790097 |
---|---|
Provider Name | Holly Avery Dunn |
First Address | Rocklin, CA 95677-4135 |
Second Address | Rocklin, CA 95677-4135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2015 |
Last Update Date | 22/05/2015 |