Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21192 | CA |
NPI | 1003060559 |
---|---|
Provider Name | Lizabeth Jean Bunkell |
First Address | Santa Clarita, CA 91351-2357 |
Second Address | Santa Clarita, CA 91351-2357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 11/11/2008 |