Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT14658 | CA |
NPI | 1053543512 |
---|---|
Provider Name | Lynn Marie Baltimore |
First Address | Los Osos, CA 93402-1426 |
Second Address | Los Osos, CA 93402-1426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 18/08/2009 |