Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT15341 | CA |
NPI | 1598034399 |
---|---|
Provider Name | Lois Kim Hargreaves |
First Address | Pacifica, CA 94044-2624 |
Second Address | Mill Valley, CA 94941-6001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 22/12/2011 |