Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023653193 |
---|---|
Provider Name | Megan Mosby |
First Address | Altadena, CA 91001-4925 |
Second Address | Pasadena, CA 91103-3050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 14/01/2022 |