Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 030202035 | CA |
N | 226300000X | Kinesiotherapist | 2003200044 | CA |
NPI | 1326308883 |
---|---|
Provider Name | Keith Stumpf |
First Address | San Diego, CA 92124-1163 |
Second Address | Garden Ridge, TX 78266-2562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 17/05/2012 |