Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT8551 | CA |
NPI | 1003096892 |
---|---|
Provider Name | Melany J. Coryea |
First Address | Sacramento, CA 95865-5228 |
Second Address | Sacramento, CA 95816-5238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2007 |
Last Update Date | 08/11/2007 |