Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT26816 | CA |
NPI | 1093871741 |
---|---|
Provider Name | Jeffrey Joseph Engstrom |
First Address | San Francisco, CA 94115-3358 |
Second Address | San Francisco, CA 94115-3358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |