Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT10217 | CA |
NPI | 1104081892 |
---|---|
Provider Name | June Angela Graham |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94115-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 23/07/2008 |