Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 16484 | CA |
NPI | 1144774001 |
---|---|
Provider Name | Kathleen Jayne Doerr |
First Address | Rocklin, CA 95765-5240 |
Second Address | Rocklin, CA 95765-5240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 09/08/2016 |