Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 42118 | CA |
NPI | 1215329065 |
---|---|
Provider Name | Maria Kieu |
First Address | San Rafael, CA 94901-3993 |
Second Address | San Rafael, CA 94901-3993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2015 |
Last Update Date | 03/03/2015 |