Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 299750 | CA |
N | 2251S0007X | Physical Therapist - Sports | 299750 | CA |
NPI | 1083294839 |
---|---|
Provider Name | Kaitlyn Duckworth |
First Address | Oceanside, CA 92056-4568 |
Second Address | Vista, CA 92084-7271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 10/05/2021 |