Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 298177 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 298177 | CA |
NPI | 1063046290 |
---|---|
Provider Name | Kelly Svendsen |
First Address | Walnut Creek, CA 94598-8396 |
Second Address | Walnut Creek, CA 94598-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 06/10/2021 |