Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 39219 | CA |
NPI | 1013262302 |
---|---|
Provider Name | Lan Phuong Boehme |
First Address | Santa Monica, CA 90403-4500 |
Second Address | Woodland Hills, CA 91364-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 25/11/2014 |