Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT25533 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT25533 | CA |
NPI | 1285735431 |
---|---|
Provider Name | Jeffrey Laurence Fairley |
First Address | Arcadia, CA 91006-5834 |
Second Address | Claremont, CA 91711-4609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |