Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1805 | CA |
NPI | 1790001634 |
---|---|
Provider Name | Jennifer Kosel |
First Address | Long Beach, CA 90804-1493 |
Second Address | Long Beach, CA 90822-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2010 |
Last Update Date | 16/04/2010 |