Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 9850 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | 9850 | CA |
NPI | 1083830764 |
---|---|
Provider Name | Michele Lynn Page |
First Address | Temecula, CA 92592-6311 |
Second Address | Riverside, CA 92505-3043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |