Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 39710 | CA |
NPI | 1346661451 |
---|---|
Provider Name | Kerry John |
First Address | Los Angeles, CA 90045-4833 |
Second Address | Los Angeles, CA 90045-4833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2013 |
Last Update Date | 17/12/2013 |