Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 32191 | CA |
NPI | 1003084583 |
---|---|
Provider Name | Joel Dela Cruz Timbol |
First Address | Salt Lake City, UT 84171-1185 |
Second Address | Salt Lake City, UT 84121-6878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2008 |
Last Update Date | 18/02/2008 |