Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 60417405 | WA |
Y | 2251N0400X | Physical Therapist - Neurology | 60417405 | WA |
NPI | 1265861223 |
---|---|
Provider Name | Jordan Lucio Cabrera |
First Address | Seattle, WA 98118-5980 |
Second Address | Seattle, WA 98104-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2013 |
Last Update Date | 10/11/2013 |