Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 291700 | CA |
NPI | 1033665831 |
---|---|
Provider Name | Max Sterenson |
First Address | Los Angeles, CA 90025-5798 |
Second Address | Tarzana, CA 91356-3541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |