Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT293494 | CA |
NPI | 1437675345 |
---|---|
Provider Name | Melissa Torres |
First Address | Santa Monica, CA 90401-1409 |
Second Address | Santa Monica, CA 90401-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2017 |
Last Update Date | 22/08/2017 |