Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 25504 | CA |
NPI | 1003086034 |
---|---|
Provider Name | Kristen Marie Sorrells |
First Address | Los Angeles, CA 90035-1613 |
Second Address | Los Angeles, CA 90035-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 16/04/2008 |