Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | CA |
NPI | 1053811596 |
---|---|
Provider Name | Michael Phillip Peace |
First Address | Torrance, CA 90505-3767 |
Second Address | Torrance, CA 90505-3767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2018 |
Last Update Date | 20/02/2018 |