Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 24554 | CA |
N | 2251E1200X | Ergonomics | 24554 | CA |
N | 225XE1200X | Ergonomics | 24554 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | 24554 | CA |
N | 2251S0007X | Physical Therapist - Sports | 24554 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 24554 | CA |
NPI | 1669595112 |
---|---|
Provider Name | Kerry E.w. Pawl |
First Address | San Marcos, CA 92069-3033 |
Second Address | San Marcos, CA 92069-3033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 07/01/2010 |