Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT292512 | CA |
NPI | 1124541016 |
---|---|
Provider Name | Max Biessmann |
First Address | Laguna Niguel, CA 92677-1250 |
Second Address | Laguna Niguel, CA 92677-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2017 |
Last Update Date | 21/07/2017 |