Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 37011 | CA |
N | 2251S0007X | Physical Therapist - Sports | 37011 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 37011 | CA |
NPI | 1043587587 |
---|---|
Provider Name | Luc Fecteau |
First Address | Thousand Oaks, CA 91360-5831 |
Second Address | Thousand Oaks, CA 91360-5831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 29/11/2011 |