Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 37964 | CA |
Y | 2251N0400X | Physical Therapist - Neurology | PT37964 | CA |
NPI | 1447539937 |
---|---|
Provider Name | Melissa Brose |
First Address | Downey, CA 90242 |
Second Address | Downey, CA 90242-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 31/07/2017 |