Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT25858 | CA |
N | 2251E1200X | Ergonomics | PT25858 | CA |
N | 225XE1200X | Ergonomics | PT25858 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT25858 | CA |
N | 2251H1200X | Hand | PT25858 | CA |
N | 2251N0400X | Physical Therapist - Neurology | PT25858 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT25858 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT25858 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT25858 | CA |
NPI | 1306988274 |
---|---|
Provider Name | Lance Georgeson |
First Address | Mammoth Lakes, CA 93546-0660 |
Second Address | Mammoth Lakes, CA 93546-0660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |