Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 293704 | CA |
NPI | 1013436682 |
---|---|
Provider Name | Justin Newcomer |
First Address | Mill Valley, CA 94941-2903 |
Second Address | Mill Valley, CA 94941-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 14/09/2017 |