Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 35852 | CA |
Y | 225100000X | Physical Therapist | PT35852 | CA |
NPI | 1003047689 |
---|---|
Provider Name | Kimberly M. Maclean |
First Address | Irvine, CA 92606-8226 |
Second Address | Irvine, CA 92606-8226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 09/05/2014 |